Stent-graft placement in abdominal aortic aneurysm (IPG163)
The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on stent-graft placement in abdominal aortic aneurysms.
It replaces the previous guidance on stent-graft placement in abdominal aortic aneurysm (Interventional Procedures Guidance no. 10, September 2003). The Interventional Procedures Advisory Committee reconsidered the procedure based on the results of a systematic review commissioned by NICE, following publication of the results of the EndoVascular Aneurysm Repair (EVAR) trials.
In February 2009 NICE published guidance on Abdominal aortic aneurysm - endovascular stent-grafts that complements this guidance.
This procedure is used to treat aneurysms of the abdominal aorta.
Weakening of the wall of the aorta can lead to a dilatation of the vessel, or aneurysm. Aneurysms may rupture, causing internal bleeding.
Around 6000 operations on the aorta are carried out each year in England (Source: Hospital Episode Statistics, Department of Health, ungrossed for missing data, 2000/1), most of which are for abdominal aortic aneurysms.
Smaller aneurysms and aneurysms in people considered unfit for surgery may be managed with medical treatment alone. The standard invasive treatment for abdominal aortic aneurysm is open surgical repair. The aneurysm is cut open and a graft is sewn in above and below the weakened area to allow normal blood flow.
Stent-graft placement is a minimally invasive alternative to open surgery. In this technique, the graft is mounted on a stent, which is inserted into the aorta via a catheter in the femoral artery. The stent is opened under X-ray guidance, wedging the graft across the aneurysm.
An OPCS-4 code is selected from the following to capture the position of the aneurysm in the aorta:
L27.1 Endovascular insertion of stent graft for infrarenal abdominal aortic aneurysm
L27.2 Endovascular insertion of stent graft for suprarenal aortic aneurysm
L27.4 Endovascular insertion of stent graft for aortic dissection in any position
L27.5 Endovascular insertion of stent graft for aortic aneurysm of bifurcation NEC
L27.6 Endovascular insertion of stent graft for aorto-uniiliac aneurysm
L27.8 Other specified transluminal insertion of stent graft for aneurysmal segment of aorta
L27.9 Unspecified transluminal insertion of stent graft for aneurysmal segment of aorta
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 orY78.- 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
- IPG163 Stent-graft placement in abdominal aortic aneurysm - guidance
- IPG163 Stent-graft placement in abdominal aortic aneurysm: guidance (Web format)
- IPG163 Stent-graft placement in abdominal aortic aneurysm - information for the public
- Interventional Procedure Consultation Document - Stent-graft placement in abdominal aortic aneurysm
- A systematic review update of the recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysms
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Information for the public
Implementation tools and resources
- None available
The summary of the key recommendations in the guidance written for patients, carers and those with little medical knowledge and may be used in local patient information leaflets.
Quick Reference Guide
The quick reference guide presents recommendations for health professionals
The published NICE clinical guidance, contains the recommendations for health professionals and NHS bodies.
The published full clinical guidance for specialists with background, evidence, recommendations and methods used.