Endovascular stent-graft placement in thoracic aortic aneurysms and dissections

Summary

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on endovascular stent-graft placement in thoracic aortic aneurysms and dissections.

Description

This procedure is used to treat aneurysms of the descending aorta within the thorax.  Weakening of the wall of the aorta, due to atheroma, high blood pressure, or, less commonly, infection, can lead to an aneurysm. Aneurysms may rupture, causing internal bleeding.

Aneurysms of the thoracic aorta are potentially serious. Untreated, five year survival is 10 to 15%. Ruptured thoracic aneurysm is almost always fatal, even with treatment. 

Aneurysms of the thoracic aorta are relatively uncommon. Conventional surgery involves replacing the affected part of the aorta with a graft. The operation usually takes several hours and postoperative recovery can be prolonged.

Stenting involves placing a tube inside the aorta under X-ray control. Specialized catheters and wires are used to introduce the stent, most commonly through the femoral artery.

OPCS4.6 Code(s):

An OPCS-4 code is selected from the following to capture the dissection or aneurysm in the aorta:

L27.3 Endovascular insertion of stent graft for thoracic aortic aneurysm

L27.4 Endovascular insertion of stent graft for aortic dissection in any position

 

A supplementary code from category O20.- Endovascular placement of stent graft is assigned to indicate the number and type of stent grafts.

Y53.- Approach to organ under image control

or Y78.- Arteriotomy approach to organ under image control

 

Note:  Codes within categories Y53.- and Y78.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to organ under image control is assigned.

_{The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding}

Details

Contact details:

Links:

	IPG127 Endovascular stent-graft placement in thoracic aortic aneurysms and dissections - guidance	22 June 2005
	IPG127 Endovascular stent-graft placement in thoracic aortic aneurysms and dissections: guidance (Web format)	15 February 2011
	IPG127 Endovascular stent-graft placement in thoracic aortic aneurysms and dissections - information for people considering the procedure, and for the public	22 June 2005
	Interventional Procedure Consultation Document - endovascular stent-graft placement in thoracic aortic aneurysms and dissections	22 February 2005
	A systematic review of the recent evidence for the efficacy and safety relating to the use of endovascular stent-graft (ESG) placement in the treatment of thoracic aortic aneurysms.	22 February 2005