CPT® Code 34800

Deleted

1. Indications

The endovascular repair of infrarenal abdominal aortic aneurysm or dissection is indicated for patients presenting with specific vascular conditions that necessitate intervention. The following are the explicitly provided indications for this procedure:

• Infrarenal Abdominal Aortic Aneurysm - This condition involves the abnormal enlargement of the abdominal aorta below the renal arteries, which poses a risk of rupture and requires surgical repair.
• Aortic Dissection - This serious condition occurs when there is a tear in the inner layer of the aorta, leading to separation of the layers of the aortic wall, which can result in life-threatening complications.

2. Procedure

The procedure for endovascular repair of an infrarenal abdominal aortic aneurysm or dissection involves several critical steps, each designed to ensure the successful placement of the aorto-aortic tube prosthesis. The following procedural steps are outlined:

• Step 1: Incision and Access - A small incision is made in the groin area over the femoral artery to gain access to the vascular system. This access point is crucial for the introduction of the necessary instruments for the procedure.
• Step 2: Guide Wire Placement - A trocar is inserted into the femoral artery, and a guide wire is advanced through the external and common iliac arteries into the aorta. This guide wire serves as a pathway for subsequent instruments.
• Step 3: Advancing the Guide Wire - The guide wire is carefully advanced through the aneurysm to a location just above the renal arteries. This positioning is essential for the proper placement of the prosthesis.
• Step 4: Catheter Introduction - A second guide wire and catheter may be introduced to mark the lower renal artery, providing a reference point for the placement of the prosthesis.
• Step 5: Prosthesis Placement - An introducer sheath containing the compressed aorto-aortic tube prosthesis is advanced over the guide wire and positioned in the aorta. The proximal edge of the prosthesis is placed below the renal arteries but above the top of the aneurysm defect, while the distal edge is positioned below the bottom of the defect.
• Step 6: Deployment of the Prosthesis - If a second catheter has been placed at the lower renal artery, it is withdrawn. The prosthesis is then deployed (expanded) under fluoroscopic guidance, which is separately reportable. This step is critical for ensuring the correct placement of the prosthesis.
• Step 7: Verification of Placement - The correct placement of the prosthesis is verified fluoroscopically, ensuring that it is positioned accurately within the aorta.
• Step 8: Balloon Catheter Introduction - The introducer sheath is removed, and a balloon catheter is introduced and expanded to secure the proximal and distal ends of the prosthesis, ensuring a tight fit against the aortic wall.
• Step 9: Angiography - A pigtail or sidehole catheter is introduced over the guide wire, and angiography is performed to evaluate the position of the endograft, the patency of the renal and hypogastric arteries, and to check for any endoleaks. Additionally, the patency of the lumbar and inferior mesenteric arteries is assessed.
• Step 10: Closure - After the evaluation is complete, all catheters and guide wires are removed, and the groin incision is closed, completing the procedure.

3. Post-Procedure

Post-procedure care following the endovascular repair of an infrarenal abdominal aortic aneurysm or dissection involves monitoring the patient for any complications and ensuring proper recovery. Patients are typically observed for signs of bleeding, infection, or any vascular complications. Follow-up imaging studies may be required to assess the integrity of the prosthesis and the patency of the aorta and associated arteries. Patients are advised on activity restrictions and may require medication to manage pain and prevent complications such as thrombosis. The healthcare team will provide specific instructions tailored to the individual patient's needs to ensure a smooth recovery process.