CPT® Code 34804

Deleted

1. Indications

The endovascular repair of an infrarenal abdominal aortic aneurysm or dissection is indicated for patients presenting with 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 aortic wall layers and potential life-threatening complications.

2. Procedure

The procedure for endovascular repair of an infrarenal abdominal aortic aneurysm or dissection involves several critical steps:

• Step 1: An incision is made in the groin over the femoral artery to gain access for the procedure.
• Step 2: A trocar is inserted, and a guide wire is advanced from the femoral artery through the external and common iliac arteries into the aorta.
• Step 3: The guide wire is navigated through the aneurysm to a position just above the renal arteries. A second guide wire and catheter may be introduced to mark the lower renal artery.
• Step 4: A roadmapping angiogram is obtained to visualize the anatomy prior to the introduction of the prosthesis.
• Step 5: The contralateral femoral artery is exposed, and a sheath and catheter with a snare system are placed to facilitate the capture of the contralateral iliac limb.
• Step 6: An introducer sheath containing the compressed unibody bifurcated prosthesis is introduced. Due to the size of the unibody sheath, a larger incision in the femoral artery is required.
• Step 7: The sheath is advanced over the guide wire and positioned in the aorta, ensuring the proximal edge is below the renal arteries but above the top of the aneurysm defect, while the distal edge lies below the bottom of the aneurysm defect in the ipsilateral iliac artery.
• Step 8: If a second catheter is in place at the lower renal artery, it is withdrawn. The main component of the prosthesis is then deployed (expanded) under separately reportable fluoroscopic guidance.
• Step 9: Correct placement of the prosthesis is verified fluoroscopically. The introducer sheath is removed, and a balloon catheter is introduced and expanded to secure the proximal and distal ends of the prosthesis.
• Step 10: The guide wire in the contralateral groin is snared and exits on the ipsilateral side. This wire is retracted, and the iliac limb is pulled across the aortic bifurcation into the iliac artery.
• Step 11: The distal end of the iliac limb is positioned in the iliac artery just beyond the aneurysm in a segment of normal diameter, with correct position confirmed fluoroscopically.
• Step 12: The contralateral iliac limb is deployed and seated using a balloon catheter, which is then removed.
• Step 13: A pigtail or side-hole catheter is introduced over the guide wire, and angiography is performed to evaluate the endograft position, patency of renal and hypogastric arteries, and to ensure there are no endoleaks.
• Step 14: Patency of lumbar and inferior mesenteric arteries is also checked. Finally, 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 be advised on activity restrictions and follow-up imaging studies to evaluate the success of the repair and the patency of the aorta and iliac arteries. Regular follow-up appointments are essential to monitor the long-term outcomes of the procedure.