CPT® Code 34802

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 indications are explicitly recognized for this procedure:

• Infrarenal Abdominal Aortic Aneurysm - A significant dilation of the abdominal aorta located below the renal arteries, which poses a risk of rupture.
• Aortic Dissection - A serious condition where there is a tear in the aorta's inner layer, leading to separation of the layers of the aorta.

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 prosthesis. The following procedural steps are outlined:

• Step 1: Incision and Access - An incision is made in the groin over the femoral artery to gain access to the vascular system. A trocar is then placed to facilitate the introduction of a guide wire.
• Step 2: Guide Wire Advancement - The guide wire is advanced from the femoral artery through the external and common iliac arteries into the aorta. It is then navigated through the aneurysm to a point just above the renal arteries.
• Step 3: Roadmapping Angiogram - A roadmapping angiogram is obtained to visualize the anatomy and confirm the positioning before the introduction of the prosthesis.
• Step 4: Contralateral Access - The contralateral femoral artery is exposed, and a sheath and catheter with a snare system are placed to facilitate the placement of the docking limb.
• Step 5: Main Component Deployment - An introducer sheath containing the compressed main component of the bifurcated prosthesis is advanced over the guide wire and positioned in the aorta. The main component is deployed under fluoroscopic guidance, ensuring correct placement.
• Step 6: Balloon Catheter Use - A balloon catheter is introduced and expanded to secure the proximal and distal ends of the prosthesis, ensuring a proper fit within the aorta.
• Step 7: Docking Limb Placement - A single docking limb is placed on the contralateral side. The guide wire in the contralateral groin is advanced into the docking port, and the introducer sheath containing the docking limb is introduced and firmly seated.
• Step 8: Limb Deployment - The distal end of the limb is positioned in the iliac artery beyond the aneurysm, and correct positioning is confirmed fluoroscopically before deploying the limb.
• Step 9: Angiography for Evaluation - A pigtail or sidehole catheter is introduced over the guide wire, and angiography is performed to evaluate the endograft position, patency of renal and hypogastric arteries, and to check for any endoleaks.
• Step 10: Closure - Finally, catheters and guide wires are removed, and the groin incisions are closed to complete the procedure.

3. Post-Procedure

Post-procedure care following the endovascular repair of an infrarenal abdominal aortic aneurysm or dissection typically involves monitoring the patient for any immediate complications, such as bleeding or infection at the incision site. Patients may be advised to limit physical activity for a specified period to promote healing. Follow-up imaging studies, such as ultrasound or CT scans, may be scheduled to assess the integrity of the prosthesis and ensure there are no complications, such as endoleaks. The healthcare team will provide specific instructions regarding medication management, including antiplatelet therapy, and any necessary lifestyle modifications to support recovery and vascular health.