CPT® Code 34704

Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the iliac bifurcation; for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)

The CPT® Code 34704 refers to the endovascular repair procedure of the infrarenal aorta and/or iliac artery(ies) utilizing an aorto-uni-iliac endograft. This procedure is critical in managing vascular conditions such as aneurysms, pseudoaneurysms, dissections, penetrating ulcers, and traumatic disruptions. The endograft is a specialized device made from a non-permeable polyester material, which is supported by a self-expanding flexible metal frame. This design allows for a gradual tapering from the aortic attachment site down to the iliac artery attachment site, facilitating a secure fit within the vascular anatomy. The procedure can be performed either as a preventive measure prior to an aortic rupture, aimed at reducing pressure on the vessel and minimizing the risk of further dilation and rupture, or as an urgent intervention following a rupture to effectively seal the damaged vessel and control hemorrhaging. The deployment of the endograft involves the introduction of a guidewire into the abdominal aorta through the femoral artery or distal external iliac artery, followed by the positioning of the endograft using fluoroscopic guidance. Once positioned, the endograft is partially deployed, ensuring that the upper aortic portion is correctly placed proximally to the non-aneurysmal aortic neck and distally to the iliac artery. A balloon is then utilized to expand the graft against the vessel wall, ensuring a tight seal from proximal to distal. In cases of rupture, rapid control of hemorrhaging is paramount; if the endograft cannot be deployed quickly enough, a balloon occlusion device may be inflated in the aorta proximal to the rupture site to manage bleeding. Additionally, the placement of the aorto-uni-iliac endograft necessitates the occlusion of the contralateral common iliac artery with an endovascularly placed device, along with the restoration of blood flow to the lower limb through a conventional femoral-femoral crossover bypass graft.