klthompson
Contributor
Please help with the Op Report below.
NAME OF OPERATION
Placement of a Gore-Tex stent graft to the abdominal bi-iliac position.
DESCRIPTION OF OPERATION
The patient is a 67-year-old male who was taken to the Operating Room and placed in the reclining position, induced with general endotracheal anesthesia. Both groins were prepped with Betadine and draped in the usual fashion. The main body of the stent graft was placed on the right side. We initially punctured both common femoral arteries. We opened both groins with curvilinear incisions. We dissected out the common femoral, profunda femoral, and superficial femoral arteries. Tapes were placed about all 3 branches. The patient was systemically heparinized with 7500 units of heparin. We used an 18-gauge needle to puncture the common femoral arteries. We placed 0.035-J wires bilaterally into the abdominal aorta, which was followed with a 7-French sheath. On the right side a pigtail catheter was placed above the renal arteries over the J wire and the 7-French sheath. This was positioned with fluoroscopy over the aortic neck and angled at 20-degree LAO position. We shot an aortogram of the abdominal aorta which demonstrated bilateral iliac run-off and we marked the position of the renal arteries. At this time, we exchanged an Amplatzer wire through the sheath on the right side and an 18-French sheath was placed over the Amplatzer wire. The body of the Gore-Tex graft was then placed at the level of the renal arteries, positioning this such that it would lie just below the take-off of the left renal. We released the body of the graft down to the level of the gate without completing the full release on the limb on the right side. At this time, we used a glide wire and Bernstein catheter and we were unable to wire the gate. For these reasons, we were forced to complete the release of the limb on the right side and we then placed a UF catheter on the patient's right side and tunneled a glide wire down through the limb on the left side to the level of the femoral artery. We then pulled the glide wire from the left femoral artery and passed a catheter over the glide wire into the aortic graft. We placed a pig catheter over the glide wire and this was twirled to ensure that we were within the body of the aortic graft. With the pig catheter, we were able to measure the distance from the left limb of the graft to the left hypogastric artery. We performed a left iliac arteriogram, retrograde, through a sheath in the left groin to further validate the position of the hypogastric. Because of the long length of the limb on the left side, we were forced to place a Gore-Tex 14-mm x 7-cm limb from the gate on the left side, and then we extended this with a 23-mm x 14-cm addition at the level of the hypogastric artery on the left side. On the right side similarly the right limb was short and we had to place an extension graft of an 18-mm x 10-cm extension on the right limb to get to the level of the hypogastric artery. Similarly we performed a retrograde left iliac arteriogram through the sheath in the right groin in order to document the position of the hypogastric artery. At this time Amplatzer wires were in both groins that came up through the body of the graft. We passed the low compliance balloon over the Amplatzer wires and we performed a balloon dilatation at the aortic neck. The balloon was then brought down and we performed balloon dilatations throughout the entire extended limb on the right side all the way down to the hypogastric artery. We then removed this balloon and it was passed over an Amplatzer wire on the left side, and we performed balloon dilatation of the entire left limb with its extension grafts down to the hypogastric artery. At this time, we removed the balloon and a pig catheter was placed over the Amplatzer wire on the left side and positioned just above the body of the graft. A 20-mL aortogram was injected to test seating of the graft in the neck of the aneurysm. This demonstrated no evidence of leaks. We then performed retrograde iliac arteriography through the 12-French sheaths which were located bilaterally in the groin to evaluate both limbs of the aortic graft which demonstrated no evidence of leak on either side. At this time, we removed both 12-French sheaths and performed an open repair of the common femoral artery on the right side which was done by Dr. Norris with 6-0 Prolene in a running fashion. Dr. XXXX did a repair on the left side similarly with 6-0 Prolene in a running fashion. The patient had good pulses in both feet.
FINAL PROCEDURE
We performed an aortogram to initiate the operation to define the position of both renal arteries which demonstrated diffuse atherosclerosis involving both renal arteries. The left renal artery was lowest in position. There was no hemodynamic compromise of either renal artery. There was a 2-cm aortic neck which was marked and there was bilateral iliac run-off with patency of both hypogastric arteries bilaterally. We positioned a 28 x 14-mm Gore-Tex stented graft in the abdominal aorta with the body placed on the right side. This required an extension of an 18-mm x 10-cm limb on the right side, and 2 extensions on the left side, a 14-mm x 7-cm in length and 23-mm x 14-cm in length. We performed balloon angioplasty of the aortic neck to seat the aortic graft within the neck of the aneurysm and similarly we performed 3 balloon angioplasties throughout the right iliac limb down to the hypogastric, and we performed 3 balloon angioplasties of the left iliac limb down to the hypogastric. We performed retrograde iliac arteriography on the right side documenting the position of the right hypogastric artery which demonstrated it to be patent with mild dilatation of the distal common iliac at the take-off of the hypogastric artery, requiring a bell-bottom taper to the distal limb on the right side. There was good run-off to the right common femorals. On the left side we similarly performed a retrograde iliac arteriogram documenting the patency of the hypogastric. We marked its position and this also demonstrated some mild aneurysmal dilatation involving the distal common iliac requiring utilization of a bell-bottom 23-mm graft on the left side to deal with the aneurysmal formation.
NAME OF OPERATION
Placement of a Gore-Tex stent graft to the abdominal bi-iliac position.
DESCRIPTION OF OPERATION
The patient is a 67-year-old male who was taken to the Operating Room and placed in the reclining position, induced with general endotracheal anesthesia. Both groins were prepped with Betadine and draped in the usual fashion. The main body of the stent graft was placed on the right side. We initially punctured both common femoral arteries. We opened both groins with curvilinear incisions. We dissected out the common femoral, profunda femoral, and superficial femoral arteries. Tapes were placed about all 3 branches. The patient was systemically heparinized with 7500 units of heparin. We used an 18-gauge needle to puncture the common femoral arteries. We placed 0.035-J wires bilaterally into the abdominal aorta, which was followed with a 7-French sheath. On the right side a pigtail catheter was placed above the renal arteries over the J wire and the 7-French sheath. This was positioned with fluoroscopy over the aortic neck and angled at 20-degree LAO position. We shot an aortogram of the abdominal aorta which demonstrated bilateral iliac run-off and we marked the position of the renal arteries. At this time, we exchanged an Amplatzer wire through the sheath on the right side and an 18-French sheath was placed over the Amplatzer wire. The body of the Gore-Tex graft was then placed at the level of the renal arteries, positioning this such that it would lie just below the take-off of the left renal. We released the body of the graft down to the level of the gate without completing the full release on the limb on the right side. At this time, we used a glide wire and Bernstein catheter and we were unable to wire the gate. For these reasons, we were forced to complete the release of the limb on the right side and we then placed a UF catheter on the patient's right side and tunneled a glide wire down through the limb on the left side to the level of the femoral artery. We then pulled the glide wire from the left femoral artery and passed a catheter over the glide wire into the aortic graft. We placed a pig catheter over the glide wire and this was twirled to ensure that we were within the body of the aortic graft. With the pig catheter, we were able to measure the distance from the left limb of the graft to the left hypogastric artery. We performed a left iliac arteriogram, retrograde, through a sheath in the left groin to further validate the position of the hypogastric. Because of the long length of the limb on the left side, we were forced to place a Gore-Tex 14-mm x 7-cm limb from the gate on the left side, and then we extended this with a 23-mm x 14-cm addition at the level of the hypogastric artery on the left side. On the right side similarly the right limb was short and we had to place an extension graft of an 18-mm x 10-cm extension on the right limb to get to the level of the hypogastric artery. Similarly we performed a retrograde left iliac arteriogram through the sheath in the right groin in order to document the position of the hypogastric artery. At this time Amplatzer wires were in both groins that came up through the body of the graft. We passed the low compliance balloon over the Amplatzer wires and we performed a balloon dilatation at the aortic neck. The balloon was then brought down and we performed balloon dilatations throughout the entire extended limb on the right side all the way down to the hypogastric artery. We then removed this balloon and it was passed over an Amplatzer wire on the left side, and we performed balloon dilatation of the entire left limb with its extension grafts down to the hypogastric artery. At this time, we removed the balloon and a pig catheter was placed over the Amplatzer wire on the left side and positioned just above the body of the graft. A 20-mL aortogram was injected to test seating of the graft in the neck of the aneurysm. This demonstrated no evidence of leaks. We then performed retrograde iliac arteriography through the 12-French sheaths which were located bilaterally in the groin to evaluate both limbs of the aortic graft which demonstrated no evidence of leak on either side. At this time, we removed both 12-French sheaths and performed an open repair of the common femoral artery on the right side which was done by Dr. Norris with 6-0 Prolene in a running fashion. Dr. XXXX did a repair on the left side similarly with 6-0 Prolene in a running fashion. The patient had good pulses in both feet.
FINAL PROCEDURE
We performed an aortogram to initiate the operation to define the position of both renal arteries which demonstrated diffuse atherosclerosis involving both renal arteries. The left renal artery was lowest in position. There was no hemodynamic compromise of either renal artery. There was a 2-cm aortic neck which was marked and there was bilateral iliac run-off with patency of both hypogastric arteries bilaterally. We positioned a 28 x 14-mm Gore-Tex stented graft in the abdominal aorta with the body placed on the right side. This required an extension of an 18-mm x 10-cm limb on the right side, and 2 extensions on the left side, a 14-mm x 7-cm in length and 23-mm x 14-cm in length. We performed balloon angioplasty of the aortic neck to seat the aortic graft within the neck of the aneurysm and similarly we performed 3 balloon angioplasties throughout the right iliac limb down to the hypogastric, and we performed 3 balloon angioplasties of the left iliac limb down to the hypogastric. We performed retrograde iliac arteriography on the right side documenting the position of the right hypogastric artery which demonstrated it to be patent with mild dilatation of the distal common iliac at the take-off of the hypogastric artery, requiring a bell-bottom taper to the distal limb on the right side. There was good run-off to the right common femorals. On the left side we similarly performed a retrograde iliac arteriogram documenting the patency of the hypogastric. We marked its position and this also demonstrated some mild aneurysmal dilatation involving the distal common iliac requiring utilization of a bell-bottom 23-mm graft on the left side to deal with the aneurysmal formation.