CPT® Code 34845

Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery)

The procedure described by CPT® Code 34845 involves the endovascular repair of the visceral aorta and the infrarenal abdominal aorta, which may be necessary due to various conditions such as aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions. This repair is accomplished using a fenestrated visceral aortic endograft, which is specifically designed with openings (fenestrations) that align with the ostia of the superior mesenteric, celiac, and renal arteries. This design allows for the continued flow of blood into these critical branches while effectively sealing off the damaged area of the aorta. The procedure is initiated with an incision made in the groin to access the femoral artery, through which a trocar is inserted. A guidewire is then advanced through the arterial system into the aorta, allowing for the subsequent placement of the endograft. The endograft is carefully positioned to ensure that it covers the defect in the aorta, with the proximal edge situated above the involved visceral arteries and the distal edge below the defect. The deployment of the endograft is performed under fluoroscopic guidance to ensure accurate placement and to verify that the fenestrations align correctly with the visceral arteries. In addition to the fenestrated endograft, a unibody or modular infrarenal aortic endograft is also utilized to provide comprehensive coverage of the aortic defect. The procedure includes the placement of a visceral artery endoprosthesis, which is a stent that is deployed through the openings in the endograft to maintain patency in the visceral arteries. Following the deployment, angiography is conducted to assess the positioning of the endograft and stents, ensuring there are no complications such as endoleaks. The procedure concludes with the removal of catheters and guidewires, followed by the closure of the incision in the groin.