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.

Description

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.

Coding recommendations

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.

Plus

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.