Need help. The doctor telling me he did one procedure but I keep coming up with another
PREOPERATIVE DIAGNOSES:
1. A 5 cm abdominal aortic aneurysm.
2. A 3 cm left iliac aneurysm.
POSTOPERATIVE DIAGNOSES:
1. A 5 cm abdominal aortic aneurysm.
2. A 3 cm left iliac aneurysm.
Procedures:
1. Endovascular aortic repair with a 28 x 3.3 Gore Excluder tube graft 26 x 3.3
proximal extension.
2. Left iliac artery aneurysm repair with a 12 x 14 cm Excluder limb.
3. Embolization of left internal iliac artery with an 8 mm Amplatzer plug.
4. Abdominal aortogram.
5. Aortogram with iliofemoral runoff.
6. Bilateral catheter in aorta.
7. Ultrasound access of the left common femoral artery.
8. Percutaneous closure of the left common femoral artery and 6-French Mynx
closure of right common femoral artery.
BRIEF OPERATIVE DESCRIPTION: The patient was brought in to the Operating Room
table, was placed in a decubitus supine position and was prepped and draped in a
sterile fashion with chlorhexidine solution. Under local anesthetic, the left
common femoral artery was accessed using an 18-gauge needle and a J-wire was
then placed into the left common femoral artery. A 6-French sheath was then
placed at this time using a glide catheter and a Glidewire. The prior Cook
graft that was placed in the left iliac artery was selected using a glide
catheter and a Glidewire. At this time, it was exchanged to a J-wire. The
ProGlide Perclose was then used to place two stay sutures on the common femoral
artery, both at 2 o'clock and 10:00 o'clock. At this time, the Percloses were
placed at both lateral sides. A skin incision was made of 1 cm to 1.5 cm. A
6-French Cook 45 cm sheath was then placed. The internal iliac artery was
selected using a glide catheter and a Glidewire and the Cook sheath was then
telescoped over the glide catheter after selecting and placing into the internal
iliac artery. The Cook catheter was then telescoped into the internal iliac
artery. An Amplatzer plug was then placed into the internal iliac artery. An
8-mm Amplatzer plug was used to embolize the hypogastric internal iliac artery
successfully. A follow-up angiogram showed excellent positioning of the plug with slow flow through the internal iliac. At this time, the sheath was then used to select the common iliac
artery again with the glide catheter and Glidewire. The glide catheter was
then placed into the mid abdominal aorta and an Amplatz wire was then placed
into the mid thoracic aorta and an 18-Fr sheath was placed on the left side. At this time, the right common femoral artery was
then accessed using an 18-gauge needle and exchanged and a J-wire was then
placed and a 5-French sheath was then placed. A pigtail catheter was placed
over the Glidewire into the abdominal aorta. The pigtail catheter was then
placed at the level of L1 and T12. An abdominal aortogram showed the renals to be at the level of L1/L2 with appropriate neck for endovascular repair. The pseudoaneurysm was also clearly seen. At this time, the 26 x 3.3 cm aortic cuff was then placed into the abdominal aorta distal to the renal arteries, was deployed. The 5 cm pseudoaneurysm was coming off the right portion of
the abdominal aorta. The aortic cuff was deployed successfully. An extending 28.5 x 3.3 cm
aortic graft was then deployed with a 50% overlap
and was deployed successfully without any angioplasty. A repeat aortogram
demonstrated no endoleak and complete seal of the pseudoaneurysm of the proximal
anastomosis of the previous aortobifemoral bypass. At this time, a marker
pigtail catheter was then placed into the left common iliac artery and a 12mm x 14
cm Excluder limb was then deployed from the left common iliac artery down to
the external iliac artery covering the area of the hypogastric that was
successfully embolized. The limb was profiled with a 10-mm
balloon. A completion angiogram demonstrated no endoleaks proximally or distally and good flow past the area of the covered stent graft. At this time, the sheath was then removed and the Perclose stitch on the left common femoral artery was then tightened and good hemostasis was
achieved. The wire was then removed and manual pressure was held for 20
minutes. The right common femoral artery was closed with a 6-French Mynx
closure device that was closed successfully with no complications. The patient
was then transferred to the Recovery Room. Case was performed totally
percutaneous with IV sedation with no general anesthesia due to the high risk of
the procedure for this patient due to a low ejection fraction. The patient
tolerated the procedure.
PREOPERATIVE DIAGNOSES:
1. A 5 cm abdominal aortic aneurysm.
2. A 3 cm left iliac aneurysm.
POSTOPERATIVE DIAGNOSES:
1. A 5 cm abdominal aortic aneurysm.
2. A 3 cm left iliac aneurysm.
Procedures:
1. Endovascular aortic repair with a 28 x 3.3 Gore Excluder tube graft 26 x 3.3
proximal extension.
2. Left iliac artery aneurysm repair with a 12 x 14 cm Excluder limb.
3. Embolization of left internal iliac artery with an 8 mm Amplatzer plug.
4. Abdominal aortogram.
5. Aortogram with iliofemoral runoff.
6. Bilateral catheter in aorta.
7. Ultrasound access of the left common femoral artery.
8. Percutaneous closure of the left common femoral artery and 6-French Mynx
closure of right common femoral artery.
BRIEF OPERATIVE DESCRIPTION: The patient was brought in to the Operating Room
table, was placed in a decubitus supine position and was prepped and draped in a
sterile fashion with chlorhexidine solution. Under local anesthetic, the left
common femoral artery was accessed using an 18-gauge needle and a J-wire was
then placed into the left common femoral artery. A 6-French sheath was then
placed at this time using a glide catheter and a Glidewire. The prior Cook
graft that was placed in the left iliac artery was selected using a glide
catheter and a Glidewire. At this time, it was exchanged to a J-wire. The
ProGlide Perclose was then used to place two stay sutures on the common femoral
artery, both at 2 o'clock and 10:00 o'clock. At this time, the Percloses were
placed at both lateral sides. A skin incision was made of 1 cm to 1.5 cm. A
6-French Cook 45 cm sheath was then placed. The internal iliac artery was
selected using a glide catheter and a Glidewire and the Cook sheath was then
telescoped over the glide catheter after selecting and placing into the internal
iliac artery. The Cook catheter was then telescoped into the internal iliac
artery. An Amplatzer plug was then placed into the internal iliac artery. An
8-mm Amplatzer plug was used to embolize the hypogastric internal iliac artery
successfully. A follow-up angiogram showed excellent positioning of the plug with slow flow through the internal iliac. At this time, the sheath was then used to select the common iliac
artery again with the glide catheter and Glidewire. The glide catheter was
then placed into the mid abdominal aorta and an Amplatz wire was then placed
into the mid thoracic aorta and an 18-Fr sheath was placed on the left side. At this time, the right common femoral artery was
then accessed using an 18-gauge needle and exchanged and a J-wire was then
placed and a 5-French sheath was then placed. A pigtail catheter was placed
over the Glidewire into the abdominal aorta. The pigtail catheter was then
placed at the level of L1 and T12. An abdominal aortogram showed the renals to be at the level of L1/L2 with appropriate neck for endovascular repair. The pseudoaneurysm was also clearly seen. At this time, the 26 x 3.3 cm aortic cuff was then placed into the abdominal aorta distal to the renal arteries, was deployed. The 5 cm pseudoaneurysm was coming off the right portion of
the abdominal aorta. The aortic cuff was deployed successfully. An extending 28.5 x 3.3 cm
aortic graft was then deployed with a 50% overlap
and was deployed successfully without any angioplasty. A repeat aortogram
demonstrated no endoleak and complete seal of the pseudoaneurysm of the proximal
anastomosis of the previous aortobifemoral bypass. At this time, a marker
pigtail catheter was then placed into the left common iliac artery and a 12mm x 14
cm Excluder limb was then deployed from the left common iliac artery down to
the external iliac artery covering the area of the hypogastric that was
successfully embolized. The limb was profiled with a 10-mm
balloon. A completion angiogram demonstrated no endoleaks proximally or distally and good flow past the area of the covered stent graft. At this time, the sheath was then removed and the Perclose stitch on the left common femoral artery was then tightened and good hemostasis was
achieved. The wire was then removed and manual pressure was held for 20
minutes. The right common femoral artery was closed with a 6-French Mynx
closure device that was closed successfully with no complications. The patient
was then transferred to the Recovery Room. Case was performed totally
percutaneous with IV sedation with no general anesthesia due to the high risk of
the procedure for this patient due to a low ejection fraction. The patient
tolerated the procedure.