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Some Facts about Abdominal Aortic Aneurysms (AAA)

An aneurysm is an abnormal "bulging" of a vessel,usually due to a weakness or thinning of the vessel wall at thatlocation, caused by congenital or acquired weakness of the vessel wall.Patients may not have symptoms during the development and enlargement ofan aortic aneurysm, but when an aneurysm becomes large enough, it mayrupture and cause sudden severe pain. Shock and death follow shortlythereafter, as the patient bleeds freely from the ruptured aneurysm intothe abdominal cavity. Emergent surgical treatment of ruptured abdominalaortic aneurysms will save approximately 50% of these patients.

Since emergent treatment of ruptured aneurysmscarries a very high morbidity and mortality rate, the obvious solutionis to treat them electively before rupture. In the United States alone,there are over 200,000 new diagnoses of aortic aneurysm per year, and50,000 of these patients undergo elective surgical treatment because theaneurysms are large enough (typically >4.5 cm diameter) to representa threat of rupture. Elective surgery carries a vastly lowerperioperative morbidity and mortality than emergent surgery.

The traditional method of treating aortic aneurysmsis by open surgery directly at the aneurysm site. The first step is alarge abdominal or retroperitoneal incision followed by exposure of theaneurysm plus short regions of normal proximal and distal aorta. Aorticblood flow is stopped temporarily with large vascular clamps, and theaneurysm sac is cut open longitudinally. Working from within theaneurysm, a tubular synthetic graft is sutured to the normal diameteraorta at each end. The vascular clamps are removed, and any leaks aretreated by placing additional sutures. The aneurysm sac is then wrappedaround the new graft, and the abdomen is closed. If the aortic aneurysmextends distally into the iliac arteries a similar procedure isfollowed, but the surgeon chooses a bifurcated graft with one leg sewnto each of the iliac arteries beyond the regions of aneurysmalenlargement.

Existing CPT codes describe open treatment of aorticaneurysms and identify different locations for the repair. These codesare specific and selection is based on how far the aneurysm extendsproximally and distally. For example the most common aortic aneurysmrepair, 35081, Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, false aneurysm, and associated occlusive disease, abdominal aorta, is used for an aneurysm that starts below the renal artery origins and ends above the aortic bifurcation. Code 35091, Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, false aneurysm, and associated occlusive disease, abdominal aorta involving visceral vessels (mesenteric, celiac, renal),is used to report a more complex aortic aneurysm that extends furtherupwards and involves the very large upper abdominal aortic branches.