Endovascular stent–graft placement in thoracic aortic aneurysms and dissections

NICE interventional procedures guidance [IPG127] Published date:

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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

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