CPT® Code 34803

Deleted

1. Indications

The endovascular repair of an infrarenal abdominal aortic aneurysm or dissection using a modular bifurcated prosthesis is indicated for the following conditions:

• Infrarenal Abdominal Aortic Aneurysm: A localized enlargement of the abdominal aorta occurring below the renal arteries, which poses a risk of rupture.
• Aortic Dissection: A serious condition involving a tear in the aorta's inner layer, leading to separation of the layers of the aorta.

2. Procedure

The procedure for endovascular repair using CPT® Code 34803 involves several critical steps to ensure successful placement of the modular bifurcated prosthesis.

• Step 1: An incision is made in the groin area over the femoral artery to access the vascular system. A trocar is then inserted to facilitate the introduction of a guide wire.
• Step 2: The guide wire is advanced through the femoral artery, navigating through the external and common iliac arteries into the aorta. It is then pushed through the aneurysm to a position just above the renal arteries.
• Step 3: A second guide wire and catheter may be introduced to mark the location of the lower renal artery, and a roadmapping angiogram is obtained to visualize the anatomy before the prosthesis is introduced.
• Step 4: The contralateral femoral artery is exposed, and a sheath and catheter with a snare system are placed to assist in the placement of the docking limb.
• Step 5: An introducer sheath containing the compressed main component of the bifurcated prosthesis is advanced over the guide wire and positioned in the aorta, ensuring the proximal edge is below the renal arteries and above the top of the aneurysm defect.
• Step 6: If a second catheter is in place at the lower renal artery, it is withdrawn. The main component of the prosthesis is then deployed under fluoroscopic guidance, with correct placement verified through imaging.
• Step 7: The introducer sheath is removed, and a balloon catheter is introduced and expanded to secure the proximal and distal ends of the prosthesis in place.
• Step 8: The guide wire is left in place within the endograft on the ipsilateral side while the docking limb is placed on the contralateral side. The guide wire in the contralateral groin is advanced into the docking port.
• Step 9: The introducer sheath containing the docking limb is introduced over the contralateral guide wire and firmly seated in the docking port, with the distal end positioned in the iliac artery beyond the aneurysm.
• Step 10: Correct positioning is confirmed fluoroscopically, and the sheath is removed to deploy the limb.
• Step 11: A second docking limb is placed on the ipsilateral side using the same technique as the contralateral limb placement.
• Step 12: The balloon catheter is removed, and a pigtail or sidehole catheter is introduced over the guide wire to perform angiography, evaluating the endograft position, patency of renal and hypogastric arteries, and checking for any endoleaks.
• Step 13: The patency of lumbar and inferior mesenteric arteries is also assessed. Finally, all catheters and guide wires are removed, and the groin incisions are closed.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications, ensuring that the groin incisions are healing properly, and assessing for signs of endoleaks or other issues related to the prosthesis. Patients may require follow-up imaging studies to evaluate the position and function of the endograft, as well as to ensure the patency of the renal and iliac arteries. Recovery time may vary, but patients are typically advised to limit physical activity for a period to promote healing.