CPT Code 34846 | Description & Clinical Information
CPT 34846 describes the placement of a fenestrated endograft, with holes, under radiological guidance to repair the visceral aorta, including the celiac, superior mesenteric, and renal arteries, as well as the placement of either a one piece or multiple piece endograft in the infrarenal aorta, and two additional visceral artery endoprostheses.
Official Description
The CPT book defines CPT code 34846 as: “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 two visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])”.
Clinical Information
The procedure described by CPT code 34846 is a complex one that requires careful positioning and prepping of the patient, followed by the administration of anesthesia. Once the patient is ready, the provider makes a tiny surgical incision close to the groin area to access a femoral artery.
Subsequently, the provider introduces an endovascular device into the femoral artery and advances a guidewire into the ascending aorta. The provider then starts imaging guidance to identify the location of the aneurysm or other vascular problem that needs to be addressed. The provider then guides the wire through the site and brings it to a place above the renal arteries.
Next, the provider cuts into the opposite femoral artery, places a sheath, and moves forward another guidewire towards the ascending aorta. Afterward, the provider uses a unique device to move the fenestrated endoprosthesis into place and fixates it to achieve the required repair of the aorta. Then, under the guidance of imaging, the two additional visceral artery prostheses are then moved through the fenestrations and stationed in place.
In some cases, aortography may be performed to view the treatment site. Additionally, the provider may place either a unibody (one-piece) or modular (multipiece) endograft to repair the aorta below the kidneys. The endograft can be bifurcated unibody, modular bifurcated with docking limb(s), aortouniiliac or aortounifemoral. The target area may undergo angioplasty during the encounter, and the provider then performs a complete examination of the blood vessels to analyze the exact fixation of the endografts.
The provider will analyze the presence or absence of any persistent blood flow, or any stricture or blood clot between the arteries. Once everything has been inspected, the provider withdraws the instruments and finally applies pressure to stop any bleeding. The incision is then closed in layers.
Although this procedure may sound complicated and intense, it is crucial in repairing aneurysms and other vascular issues in patients. It offers a minimally invasive alternative to traditional open surgery, allowing for quicker recovery times and fewer complications.
In conclusion, the CPT code 34846 procedure offers a highly precise and effective solution for patients with vascular issues. The procedure involves several steps, including accessing the femoral artery, introducing an endovascular device and guidewire, imaging the treatment site, and stationing prostheses. Following the procedure, the provider carefully examines the blood vessels for any potential issues before closing up the incision. With its superior precision and minimal invasiveness, this procedure has revolutionized the treatment of various vascular diseases.
