CPT® Code 34832

1. Indications

The open repair of an infrarenal aortic aneurysm or dissection, as described by CPT® Code 34832, is indicated in the following scenarios:

• Unsuccessful Endovascular Repair This procedure is performed when previous endovascular attempts to repair the aneurysm or dissection have failed, leading to complications that necessitate a more invasive surgical approach.
• Complications from Endovascular Repair Indications include complications such as endoleaks, which are leaks that occur at the seal between the endograft and the aorta; dissection, which is a tear in the aortic wall; occlusion of major aortic branches, which can impede blood flow; or occlusion of aortic or iliac blood flow, which can lead to ischemia in the lower extremities.

2. Procedure

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

• Abdominal Incision The surgeon begins by making an abdominal incision to gain access to the aorta and the iliac and femoral vessels. This incision allows for direct visualization and manipulation of the vascular structures involved.
• Exposure of Vessels Once the incision is made, the aorta and the iliac/femoral vessels are carefully exposed to points above and below the level of the prosthesis. This exposure is crucial for the subsequent steps of the repair.
• Administration of Heparin and Clamping Intravenous heparin is administered to prevent clotting during the procedure, and vascular clamps are placed on the aorta and iliac/femoral vessels to control blood flow and minimize bleeding.
• Opening the Aneurysm The aneurysm is then opened, and any thrombus present within the aneurysm is removed. This step is essential to ensure that the area is clear for the placement of the prosthetic graft.
• Removal of Endograft Pieces Any lodged pieces of the previously placed endograft are also removed to facilitate a clean repair and to prevent future complications.
• Suturing the Prosthesis The prosthesis is sutured to the untraumatized aorta above the aneurysm at the proximal end. This connection is vital for restoring normal blood flow through the aorta.
• Checking Vascular Flow After suturing, vascular flow is checked to ensure that blood is flowing correctly through the newly placed prosthesis. Additional sutures are placed as needed to secure the graft.
• Repairing the Distal End The distal end of the prosthesis is then repaired in a similar fashion within the aorta or iliac/femoral artery(s). Again, vascular flow is checked, and additional sutures are placed as necessary.
• Final Steps Once the repairs are complete, vascular clamps are removed, anticoagulation is reversed, and any bleeding is controlled. Finally, the surgical wound is closed to complete the procedure.

3. Post-Procedure

Post-procedure care following the open repair of an infrarenal aortic aneurysm or dissection includes monitoring for any signs of complications such as bleeding, infection, or graft failure. Patients may require close observation in a recovery unit, and follow-up imaging studies may be necessary to assess the integrity of the repair and ensure proper blood flow. Pain management and rehabilitation may also be part of the recovery process, depending on the patient's overall health and the extent of the surgery performed.