DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. A 5 cm infrarenal abdominal aortic aneurysm.
2. History of recent growth from 4.2 to now 5 cm.
POSTOPERATIVE DIAGNOSES:
1. A 5 cm infrarenal abdominal aortic aneurysm.
2. History of recent growth from 4.2 to now 5 cm.
OPERATIONS PERFORMED:
1. Endovascular aneurysm repair with Gore Excluder.
2. Intraoperative angiogram x3.
3. Placement of 23 x 14 x 16 main body via the right limb.
4. Placement of 14 x 12 limb via the contralateral or left femoral approach.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION AND FINDINGS: The patient was brought to the operating room and sterilely prepped and draped in the supine position for endovascular aneurysm repair and above procedures. Preoperative prophylactic antibiotics were administered. Appropriate monitoring lines were placed by Dr. John Doe.
Transverse incisions were made in both groins. The skin and subcutaneous tissues were sharply incised. The dissection was carried down to where the common femoral, superficial femoral and profunda femoris arteries were dissected free. These were accessed via Cournand needle on the right. A 0.35 wire was placed, a Kumpe catheter was exchanged and then 0.35 Amplatz Super Stiff wire was placed up in the suprarenal position and marked for positioning.
The left common femoral artery was cannulated and a 5-French pigtail catheter was inserted at the renal arteries. The 18-French introducer was inserted on the right under fluoroscopy and was found to position quite easily. A 23 x 14 x 16 main body was deployed allowing the limbs to cross for ease of cannulation. Followup selective renal angiograms showed it to lie in good position.
The pigtail catheter was then brought down into the area of the gate. This was attempted to be cannulated, but was not able to easily do so. Therefore, the Kumpe catheter was exchanged and then a Glidewire was used to access the gate. A pigtail catheter was then passed up into the body of the graft and spun to confirm position. A contralateral 14 x 12 mm limb was placed after a retrograde angiogram confirmed the position of the hypogastric artery.
This limb was placed in the gate very nicely. A low-profile balloon was then brought up to the right and inflated along the proximal anastomosis. The gate was then inflated with a 12 x 40 mm balloon. A final angiogram was obtained through the pigtail catheter. There was no evidence of type 1a or 1b or type III endoleaks. There were two type II endoleaks consistent with lumbar arteries.
All devices were then removed. The arteriotomies were then closed with 5-0 Prolene sutures. The groins were closed in layers with 2-0 and 3-0 PDS. Skin was reapproximated with running subcuticular 4-0 undyed Vicryl. Benzoin and Steri-Strips were applied to the wound. The patient was found to have palpable pulses. The patient’s heparin was reversed with 50 mg of protamine given slowly IV. The patient was then transported to the recovery room in stable condition.
