Preoperative diagnosis: Ischemic rest pain of the lower extremity. Procedure: Right iliofemoral endarterectomy, SFA endarterectomy and patch angioplasty Postoperative diagnosis: Same.Indications: This is a 65 year-old male who presents with ischemic rest pain of the right lower extremity. The patient was found to have near occlusion of the Right external iliac and CFA Description of procedure: The patient was placed in a supine position. The procedure was performed under general endotracheal. The right lower extremitywas prepped and draped in a standard surgical fashion. The patient was given 5,000 U of heparin intravenously. Five minutes after heparin administration, the common femoral, profunda femoris, and superficial femoral arteries were clamped An arteriotomy was performed in the common femoral artery obliquely toward the SFA using a #11 blade scalpel and extended using Pott’s scissors. Extensive near occlusive plaque was noted in the External iliac artery and the CFA. This appeared to be an acute on chronic process. The arteriotomy was carried down on the Profunda and an endarterectomy performed We then proceeded to use a patch to reconstruct the artery Blood was allowed to back-bleed from the profunda femoris arteries and the iliac artery was allowed to forward-bleed. The lumen was irrigated and the anastomosis was completed. Blood flow in the superficial femoral and profunda femoris arteries was checked by both palpation and Doppler probe. Hemostasis was secured in the groin We the proceeded to perform an iliac angiogram A Micropuncture was used to gain access into the patch. We passed a 5Fr sheath and a wire was passed through several tight lesions into the EIA. An Angiogram was completed and revealed a tight lesion of the Common and EIA. We were unable to cross the lesion in a retrograde fashion and opted to have the procedure completed via upper extremity access the next day and proceeded to remove the sheath and close the patch defect. The groins were closed in three layers: The first layer with 2-0 Vicryl for closing the fascia, the second layer with 3-0 Vicryl for closing the subcutaneous tissue, and the skin with Monocryl Dressing was applied to the groin The patient tolerated the procedure well, was awakened, the lower extremities were noted for the presence of pulsations by Doppler in the DP and PT , and the patient was taken to the postanesthesia care unit in stable condition. Can someone let me know if I'm headed the right direction with 35355? I'm fairly new to this, Any thoughts are appreciated? |