TWilliam2019
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Procedure list in detail:
Right saphenous vein to left common femoral vein bypass (Palma procedure) tunneled through a 8 mm PTFE ringed bypass graft
Creation of left superficial femoral artery to bypass graft fistula with reverse saphenous vein
Ultrasound used to assist in procedure
Pre-operative Diagnosis: Pre-Op Diagnosis Codes:
* Acute embolism and thrombosis of deep vein of left proximal lower extremity (CMS/HCC) [I82.4Y2]
Post-operative Diagnosis: Post-op Diagnosis
* Acute embolism and thrombosis of deep vein of left proximal lower extremity (CMS/HCC) [I82.4Y2]
Indications:
57-year-old female with a history of prior DVT of the left lower extremity and history of left iliac vein stent who presented with chronic occlusion of the left iliac vein stent which could not be opened endovascularly due to chronicity. Patient developed evidence of chronic venous insufficiency and post thrombotic syndrome of the left lower extremity. Risk benefits and alternatives of the above procedure were discussed in detail and she was consented to proceed.
Anesthesia Type: General
Estimated Blood Loss: 50 ml
IVF: See anesthesia records for details
Implants:
Implant Name Type Inv. Item Serial No. Manufacturer Lot No. LRB No. Used Action
110845_GRAFT VASCULAR 40CM 8MM PROPATEN THIN WALL GORE-TEX HEPARIN INTEGRATED RING 40CM - S6478153PP018 - LOG351899 Implant 110845_GRAFT VASCULAR 40CM 8MM PROPATEN THIN WALL GORE-TEX HEPARIN INTEGRATED RING 40CM 6478153PP018 WL GORE N/A 1 Implanted
Antibiotics: Ancef
Complications:
None
Disposition: PACU - hemodynamically stable.
Procedure Details:
After consent was obtained the patient was taken to the operative suite and laid in the supine position. She was placed under general anesthesia and endotracheally intubated. Bilateral lower extremities were prepped and draped in the usual sterile fashion. The ultrasound was used intraoperatively to assist with the procedure by mapping out the location and size of the right common femoral and great saphenous vein which was then marked out on the leg with a sterile marking pen. Next a vertical incision was made in the right groin and dissection was carried down through the subcutaneous tissue to the common femoral vein which was sharply dissected out anteriorly and laterally. The saphenous vein was identified and sharply dissected out through to skip incisions down the medial leg. Systemic heparin was given and allowed to circulate. The right great saphenous vein was ligated distally towards the knee with 2-0 silk suture and excised from the proximal leg but left connected to the common femoral vein. The vein was irrigated with heparin saline mixed with 400 mcg of nitroglycerin and flushed easily. Small branching veins were ligated with small clips and 4-0 silk suture. The vein was inspected and small leaks were repaired with 7-0 Prolene. Next, attention was turned to the left femoral vein dissection. A vertical incision was created in the left groin and dissection was carried down through the subcutaneous tissue. The common femoral vein and its branches were sharply dissected out and controlled. A large branching vein traveling towards the abdomen was identified and harvested to later used for a fistula creation. The right great saphenous vein was then tunneled extraperitoneal through the subcutaneous tissue through an 8 mm ringed PTFE from the right to left groin incision to prevent vein compression. The vein was irrigated with heparin saline and controlled with an atraumatic bulldog. The vein was beveled appropriately and then an end-to-side anastomosis was created to the left common femoral vein with 6-0 Prolene. The common femoral vein was fore bled and the saphenous vein backbled and irrigated with heparin saline and sutures tied. The bulldog and clamps were removed and now there is flow through the vein graft. Next the left proximal superficial femoral artery was sharply dissected out proximally and distally and encircled with Vesseloops. An arteriotomy was created with 11 blade and extended with the Potts scissors. The previously harvested vein branch was beveled appropriately and reversed in an end-to-side anastomosis was created with 6-0 running Prolene. Prior to completion the vein graft was flushed with heparin saline the artery was fore bled and backbled and the vein was controlled with an atraumatic bulldog clamp. Finally the tunneled great saphenous vein graft was controlled proximally and distally just distal to the common femoral vein anastomosis and a vertical vein anatomy was created with an 11 blade scalpel and extended with Potts scissors. The reverse vein was then anastomosed end-to-side to the femorofemoral tunneled great saphenous vein with 6-0 running Prolene. After the vein was flushed backbled and fore bled the sutures were tied and flow was restored through the newly created AV fistula. The AV fistula, femorofemoral vein graft and distal pulses were all confirmed. The incisions were irrigated with normal saline mixed with Ancef. Hemostasis was achieved with small amounts of fibrillar. The AV fistula was marked with a 2-0 Prolene tied loosely around the AV fistula to identify for later ligation. 15 round JP drains were placed in both incisions on the right and left leg. 2-0 nylon sutures were used to fashion the JP to the skin. Each incision was then closed in layers with 2-0 and 3-0 PDS sutures. The skin was closed with 4-0 Monocryl in a subcuticular fashion. The skin incisions were then covered with Dermabond. Both legs were then wrapped with Kerlix and Ace wrap bilaterally. The patient was awakened from general anesthesia and extubated in the operating room without difficulty. She was then transitioned to the recovery area in stable condition.
Procedure list in detail:
Right saphenous vein to left common femoral vein bypass (Palma procedure) tunneled through a 8 mm PTFE ringed bypass graft
Creation of left superficial femoral artery to bypass graft fistula with reverse saphenous vein
Ultrasound used to assist in procedure
Pre-operative Diagnosis: Pre-Op Diagnosis Codes:
* Acute embolism and thrombosis of deep vein of left proximal lower extremity (CMS/HCC) [I82.4Y2]
Post-operative Diagnosis: Post-op Diagnosis
* Acute embolism and thrombosis of deep vein of left proximal lower extremity (CMS/HCC) [I82.4Y2]
Indications:
57-year-old female with a history of prior DVT of the left lower extremity and history of left iliac vein stent who presented with chronic occlusion of the left iliac vein stent which could not be opened endovascularly due to chronicity. Patient developed evidence of chronic venous insufficiency and post thrombotic syndrome of the left lower extremity. Risk benefits and alternatives of the above procedure were discussed in detail and she was consented to proceed.
Anesthesia Type: General
Estimated Blood Loss: 50 ml
IVF: See anesthesia records for details
Implants:
Implant Name Type Inv. Item Serial No. Manufacturer Lot No. LRB No. Used Action
110845_GRAFT VASCULAR 40CM 8MM PROPATEN THIN WALL GORE-TEX HEPARIN INTEGRATED RING 40CM - S6478153PP018 - LOG351899 Implant 110845_GRAFT VASCULAR 40CM 8MM PROPATEN THIN WALL GORE-TEX HEPARIN INTEGRATED RING 40CM 6478153PP018 WL GORE N/A 1 Implanted
Antibiotics: Ancef
Complications:
None
Disposition: PACU - hemodynamically stable.
Procedure Details:
After consent was obtained the patient was taken to the operative suite and laid in the supine position. She was placed under general anesthesia and endotracheally intubated. Bilateral lower extremities were prepped and draped in the usual sterile fashion. The ultrasound was used intraoperatively to assist with the procedure by mapping out the location and size of the right common femoral and great saphenous vein which was then marked out on the leg with a sterile marking pen. Next a vertical incision was made in the right groin and dissection was carried down through the subcutaneous tissue to the common femoral vein which was sharply dissected out anteriorly and laterally. The saphenous vein was identified and sharply dissected out through to skip incisions down the medial leg. Systemic heparin was given and allowed to circulate. The right great saphenous vein was ligated distally towards the knee with 2-0 silk suture and excised from the proximal leg but left connected to the common femoral vein. The vein was irrigated with heparin saline mixed with 400 mcg of nitroglycerin and flushed easily. Small branching veins were ligated with small clips and 4-0 silk suture. The vein was inspected and small leaks were repaired with 7-0 Prolene. Next, attention was turned to the left femoral vein dissection. A vertical incision was created in the left groin and dissection was carried down through the subcutaneous tissue. The common femoral vein and its branches were sharply dissected out and controlled. A large branching vein traveling towards the abdomen was identified and harvested to later used for a fistula creation. The right great saphenous vein was then tunneled extraperitoneal through the subcutaneous tissue through an 8 mm ringed PTFE from the right to left groin incision to prevent vein compression. The vein was irrigated with heparin saline and controlled with an atraumatic bulldog. The vein was beveled appropriately and then an end-to-side anastomosis was created to the left common femoral vein with 6-0 Prolene. The common femoral vein was fore bled and the saphenous vein backbled and irrigated with heparin saline and sutures tied. The bulldog and clamps were removed and now there is flow through the vein graft. Next the left proximal superficial femoral artery was sharply dissected out proximally and distally and encircled with Vesseloops. An arteriotomy was created with 11 blade and extended with the Potts scissors. The previously harvested vein branch was beveled appropriately and reversed in an end-to-side anastomosis was created with 6-0 running Prolene. Prior to completion the vein graft was flushed with heparin saline the artery was fore bled and backbled and the vein was controlled with an atraumatic bulldog clamp. Finally the tunneled great saphenous vein graft was controlled proximally and distally just distal to the common femoral vein anastomosis and a vertical vein anatomy was created with an 11 blade scalpel and extended with Potts scissors. The reverse vein was then anastomosed end-to-side to the femorofemoral tunneled great saphenous vein with 6-0 running Prolene. After the vein was flushed backbled and fore bled the sutures were tied and flow was restored through the newly created AV fistula. The AV fistula, femorofemoral vein graft and distal pulses were all confirmed. The incisions were irrigated with normal saline mixed with Ancef. Hemostasis was achieved with small amounts of fibrillar. The AV fistula was marked with a 2-0 Prolene tied loosely around the AV fistula to identify for later ligation. 15 round JP drains were placed in both incisions on the right and left leg. 2-0 nylon sutures were used to fashion the JP to the skin. Each incision was then closed in layers with 2-0 and 3-0 PDS sutures. The skin was closed with 4-0 Monocryl in a subcuticular fashion. The skin incisions were then covered with Dermabond. Both legs were then wrapped with Kerlix and Ace wrap bilaterally. The patient was awakened from general anesthesia and extubated in the operating room without difficulty. She was then transitioned to the recovery area in stable condition.