CPT® Code 34805

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1. Indications

The endovascular repair of infrarenal abdominal aortic aneurysm or dissection is indicated for specific conditions that necessitate intervention to prevent serious complications. The following are the primary indications for this procedure:

• Infrarenal Abdominal Aortic Aneurysm - This procedure is performed when there is a presence of an infrarenal abdominal aortic aneurysm that poses a risk of rupture or other complications.
• Aortic Dissection - The procedure is indicated in cases of aortic dissection, where there is a tear in the aorta's inner layer, leading to the potential for life-threatening outcomes.
• Single Iliac Artery Involvement - The use of an aorto-uni-iliac prosthesis is indicated when the aneurysm extends into a single iliac artery.
• Bilateral Iliac and Femoral Artery Involvement - The aorto-unifemoral prosthesis is indicated when the aneurysm affects both the iliac and femoral arteries on one side.

2. Procedure

The procedure for endovascular repair of an infrarenal abdominal aortic aneurysm or dissection involves several critical steps to ensure successful placement of the prosthesis. The following outlines the procedural steps:

• Step 1: Incision and Access - An 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 subsequent steps of 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 the subsequent placement of the prosthesis.
• Step 3: Advancing the Guide Wire - The guide wire is further advanced through the aneurysm to a point just above the renal arteries. This positioning is essential for proper placement of the prosthesis.
• Step 4: Second Guide Wire and Catheter Introduction - A second guide wire and catheter may be introduced to mark the lower renal artery, ensuring accurate placement of the prosthesis.
• Step 5: Introducer Sheath Advancement - An introducer sheath containing the compressed aorto-uni-iliac or aorto-unifemoral 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 in the iliac or femoral artery.
• Step 6: Deployment of the Prosthesis - The prosthesis is deployed (expanded) under separately reportable fluoroscopic guidance. The deployment is performed in sections, starting in the aorta. Once the aortic portion is deployed and coverage of the aneurysm is verified, the iliac and femoral portions are then deployed.
• Step 7: Verification of Placement - Correct placement of the prosthesis is verified fluoroscopically to ensure that it is positioned accurately within the vascular system.
• 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 vessel walls.
• 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, 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 confirming the successful deployment and positioning of the prosthesis, all catheters and guide wires are removed, and the groin incision is closed to complete 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 other adverse effects at the incision site. Follow-up imaging studies, such as ultrasound or CT scans, may be scheduled to assess the position of the prosthesis and the patency of the arteries. Patients are advised on activity restrictions and may require medication to manage pain or prevent complications. The healthcare team will provide specific instructions regarding follow-up appointments and any necessary lifestyle modifications to support recovery and long-term health.