shariblove
Contributor
I code Anesthesia, and this is the dictation to a case that I'm so lost on. Completely over my head, hope someone can help me, please! Doesn't help that its the end of a 10 hour day! 
thanks in advance!!
OPERATION: The patient was brought to the operating suite and placed in the supine position. After induction of general anesthesia, the right leg was prepped and draped sterilely. Previous groin incision was opened. Dissection was carried to the level of the inguinal ligament. The distal external iliac artery was attempted to be dissected free of the site of a previous bypass grafting, was absolutely scarred in. The mid common femoral artery was attempted as well, cervical arteriotomies were made, repaired with 5-0 Prolene suture. One arteriotomy was made and intraluminal occlusion attempted with 4 Fogarty catheters and this was not successful either, so that arteriotomy was closed with 5-0 Prolene suture. At this point, I elected to bring the graft off the SFA. The SFA was patent. There was proximal stenosis, but felt it was the safest option. The proximal SFA was dissected free. It was soft with a very strongly palpable pulse. The below knee incision was opened and the tibioperoneal trunk and its bifurcation dissected free. Peroneal and posterior tibial artery and tibioperoneal trunk were controlled with vessel loops. A subcutaneous tunnel was created with the Gore tunneler. The patient was systemically heparinized. Cadaveric vein was prepared on the back table, the valves were lysed with a 3 mm cutting head. The femoral vessels were controlled. The SFA was controlled with vessel loops, opened longitudinally. End-to-side anastomosis sewn with 5-0 Prolene suture. Anastomosis completed, checked and hemostatic. Flow through the vein graft was excellent. The valvulotome was passed one more time. There were no retained valves. The graft was brought through the tunnel with the Gore tunneler. The tibioperoneal trunk and peroneal and posterior tibial artery was controlled with vessel loops. The tibioperoneal trunk was opened longitudinally onto the posterior tibial artery. The graft was measured to appropriate length and spatulated. The distal anastomosis sewn in an end-to-side fashion with running 6-0 Prolene suture. Prior to its closure, the vessel was flushed, anastomosis completed, flow restored. The graft had a strong palpable pulse with an excellent Doppler signal. There was an excellent signal in the peroneal and posterior tibial artery and there was excellent posterior tibial signal at the level of the ankle. No protamine was required. A 10 mm JP drain was placed in the groin. Hemostasis was achieved and incisions were closed in several layers with 3-0 Vicryl and staples on the skin. Needle, sponge and instrument count was correct. The patient was taken to recovery room in stable condition.
thanks in advance!!OPERATION: The patient was brought to the operating suite and placed in the supine position. After induction of general anesthesia, the right leg was prepped and draped sterilely. Previous groin incision was opened. Dissection was carried to the level of the inguinal ligament. The distal external iliac artery was attempted to be dissected free of the site of a previous bypass grafting, was absolutely scarred in. The mid common femoral artery was attempted as well, cervical arteriotomies were made, repaired with 5-0 Prolene suture. One arteriotomy was made and intraluminal occlusion attempted with 4 Fogarty catheters and this was not successful either, so that arteriotomy was closed with 5-0 Prolene suture. At this point, I elected to bring the graft off the SFA. The SFA was patent. There was proximal stenosis, but felt it was the safest option. The proximal SFA was dissected free. It was soft with a very strongly palpable pulse. The below knee incision was opened and the tibioperoneal trunk and its bifurcation dissected free. Peroneal and posterior tibial artery and tibioperoneal trunk were controlled with vessel loops. A subcutaneous tunnel was created with the Gore tunneler. The patient was systemically heparinized. Cadaveric vein was prepared on the back table, the valves were lysed with a 3 mm cutting head. The femoral vessels were controlled. The SFA was controlled with vessel loops, opened longitudinally. End-to-side anastomosis sewn with 5-0 Prolene suture. Anastomosis completed, checked and hemostatic. Flow through the vein graft was excellent. The valvulotome was passed one more time. There were no retained valves. The graft was brought through the tunnel with the Gore tunneler. The tibioperoneal trunk and peroneal and posterior tibial artery was controlled with vessel loops. The tibioperoneal trunk was opened longitudinally onto the posterior tibial artery. The graft was measured to appropriate length and spatulated. The distal anastomosis sewn in an end-to-side fashion with running 6-0 Prolene suture. Prior to its closure, the vessel was flushed, anastomosis completed, flow restored. The graft had a strong palpable pulse with an excellent Doppler signal. There was an excellent signal in the peroneal and posterior tibial artery and there was excellent posterior tibial signal at the level of the ankle. No protamine was required. A 10 mm JP drain was placed in the groin. Hemostasis was achieved and incisions were closed in several layers with 3-0 Vicryl and staples on the skin. Needle, sponge and instrument count was correct. The patient was taken to recovery room in stable condition.