sandy06
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PREOPERATIVE DIAGNOSIS:
Large descending thoracic aneurysm.
POSTOPERATIVE DIAGNOSIS:
Large descending thoracic aneurysm.
OPERATION:
1. Exploration of infrarenal aorta.
2. Insertion with 10 mm conduit Dacron graft.
ANESTHESIA:
General.
SURGEON:
M, M.D.
CO-SURGEON:
A, M.D.
RESIDENT:
S, M.D.
HISTORY:
This 70-year-old female who had an ascending thoracic aneurysm was
operated on and then also developed a descending thoracic aneurysm,
and that will be treated with an endovascular treatment. For that
reason I was called in consultation in order to expose the infrarenal
aorta in order to put a conduit because the patient had very small and
very calcified femoral and popliteal arteries. The risks were fully
explained and discussed with the patient.
OPERATION:
The patient under general endotracheal anesthesia with the right side
elevated to 45 degrees the chest, the abdomen and the groin was
prepped and draped in the usual manner.
An excision was made from the left lower quadrant towards the left
upper quadrant. The muscles were divided. The retroperitoneum was
entered. With careful dissection, we were able to identify the left
ureter as well the left renal vein, and then we were able to identify
the infrarenal aorta as well as the inferior mesenteric artery. This
shows it was soft on palpation at the level of the infrarenal aorta
just an inch below the renal arteries and about 1 or 2 cm above the
bifurcation, so we selected this area in order to insert the grafting
for the conduit.
The patient received Argatroban intravenously because there was a past
history of HIT; so after this was injected, the aorta was crossclamped
above and below the takeoff of the inferior mesenteric artery. One
lumbar artery was clipped and then the aorta was opened and a 10 mm
Dacron graft was brought into the operative field. This was cut and an
end-to-side anastomosis was performed between the aorta and the graft
using 6-0 Prolene running stitches. After this anastomosis was
completed, the graft was brought toward the right groin to a second
stab wound and then they proceeded to insert the stent into the aorta
through this conduit. At the end of the procedure, the conduit was
ligated close to the aorta and removed and then the retroperitoneal
area was irrigated with antibiotic solution, and then the abdominal
wall was closed in the usual manner, the muscles in one layer with
running stitch of DVS1, subcutaneous tissue with Vicryl 2-0 running
stitches, and the skin in subcuticular stitch of Vicryl 4-0.
The endovascular procedure and the stent in the aorta was performed by
Dr. B and Dr. L.
Can someone please give me some insight on this report, I'm
I am looking at these CPT CODES 35081 OR 35091 and 34820 or 34833, but I'm confuse of this part of the report (For that
reason I was called in consultation in order to expose the infrarenal
aorta in order to put a conduit because the patient had very small and
very calcified femoral and popliteal arteries. )
Thanks.........
Large descending thoracic aneurysm.
POSTOPERATIVE DIAGNOSIS:
Large descending thoracic aneurysm.
OPERATION:
1. Exploration of infrarenal aorta.
2. Insertion with 10 mm conduit Dacron graft.
ANESTHESIA:
General.
SURGEON:
M, M.D.
CO-SURGEON:
A, M.D.
RESIDENT:
S, M.D.
HISTORY:
This 70-year-old female who had an ascending thoracic aneurysm was
operated on and then also developed a descending thoracic aneurysm,
and that will be treated with an endovascular treatment. For that
reason I was called in consultation in order to expose the infrarenal
aorta in order to put a conduit because the patient had very small and
very calcified femoral and popliteal arteries. The risks were fully
explained and discussed with the patient.
OPERATION:
The patient under general endotracheal anesthesia with the right side
elevated to 45 degrees the chest, the abdomen and the groin was
prepped and draped in the usual manner.
An excision was made from the left lower quadrant towards the left
upper quadrant. The muscles were divided. The retroperitoneum was
entered. With careful dissection, we were able to identify the left
ureter as well the left renal vein, and then we were able to identify
the infrarenal aorta as well as the inferior mesenteric artery. This
shows it was soft on palpation at the level of the infrarenal aorta
just an inch below the renal arteries and about 1 or 2 cm above the
bifurcation, so we selected this area in order to insert the grafting
for the conduit.
The patient received Argatroban intravenously because there was a past
history of HIT; so after this was injected, the aorta was crossclamped
above and below the takeoff of the inferior mesenteric artery. One
lumbar artery was clipped and then the aorta was opened and a 10 mm
Dacron graft was brought into the operative field. This was cut and an
end-to-side anastomosis was performed between the aorta and the graft
using 6-0 Prolene running stitches. After this anastomosis was
completed, the graft was brought toward the right groin to a second
stab wound and then they proceeded to insert the stent into the aorta
through this conduit. At the end of the procedure, the conduit was
ligated close to the aorta and removed and then the retroperitoneal
area was irrigated with antibiotic solution, and then the abdominal
wall was closed in the usual manner, the muscles in one layer with
running stitch of DVS1, subcutaneous tissue with Vicryl 2-0 running
stitches, and the skin in subcuticular stitch of Vicryl 4-0.
The endovascular procedure and the stent in the aorta was performed by
Dr. B and Dr. L.
Can someone please give me some insight on this report, I'm
I am looking at these CPT CODES 35081 OR 35091 and 34820 or 34833, but I'm confuse of this part of the report (For that
reason I was called in consultation in order to expose the infrarenal
aorta in order to put a conduit because the patient had very small and
very calcified femoral and popliteal arteries. )
Thanks.........