DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Abdominal aortic aneurysm.
POSTOPERATIVE DIAGNOSIS: Abdominal aortic aneurysm.
OPERATION PERFORMED: Endovascular stent graft repair of infrarenal abdominal aortic aneurysm.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
INDICATIONS FOR OPERATION: This is a (XX)-year-old Hispanic male with a past medical history significant for hypertension, high cholesterol and diabetes, who was incidentally found to have an aneurysm in his abdomen while he was getting an MRI of his back. His aneurysm was noted to be 6.2 cm in diameter. It was infrarenal in location, and he was felt to be a good candidate for endovascular stent graft closure.
DESCRIPTION OF OPERATION: The patient was identified and placed on the operating table in the supine position. General endotracheal anesthesia was induced. The chest and lower extremities were prepped and draped in the normal sterile fashion. The patient was given IV antibiotics prior to start of the case.
Standard groin incisions were made bilaterally, and the common femoral arteries were identified and dissected free from the surrounding tissues bilaterally. The common femoral arteries on both sides had dense calcification and had evidence of severe disease. We isolated these up as high as we could and isolated the areas that we felt would be good for administration of the stent graft. It was obvious that the patient had diffuse peripheral vascular disease. We heparinized the patient with 5000 units of heparin and then passed guidewires up both groins under fluoroscopic guidance and passed a pigtail catheter up into the aorta and shot an angiogram and noted the level of the takeoff of the renal arteries.
We then passed the main body of the device up the left groin and located this just below the level of the takeoff of the renal arteries and deployed the graft just below the level of the renal arteries and got good fixation below the renal arteries. We then shot another angiogram, marked the level of the takeoff at the internal and external iliacs and passed a left iliac extension up through the groin and cannulated the opposite and passed the long iliac extension up through graft and deployed this just above the takeoff of the external and internal iliac arteries.
Once this was deployed, we then shot another angiogram and noted the takeoff of the right internal and external iliac and deployed a short extension down off of here. Once we had all of our extension and they had good landings above the iliacs and below the renal arteries, we then ballooned the areas and opened up all the stents in the overlapping areas and all their proximal and distal landing zones. Once it was done, we had great fixation of the graft. We then shot an angiogram and noted that we had excluded the aneurysm. There was no evidence of any leakage and no endoleaks, and we had excellent repair.
When we were sure everything was going well, we then removed our devices from both groins, and we closed both arteries using running 5-0 Prolene stitches and closed the transverse arteriotomies using running 5-0 Prolene stitches. Once we had these closed, we then checked Doppler flow. In both groins, we had excellent dopplerable flow, and we had excellent dopplerable flow in the posterior tibial arteries bilaterally. The patient has severe disease as stated earlier, but we did have excellent pulses at the end of the case. We checked the suture lines again. When we were sure there was no bleeding and we had excellent dopplerable flow, we then reversed the heparin with protamine.
We then held pressure for several minutes. When we were sure that there was no bleeding, we then injected Marcaine in the wounds and closed the wounds in three layers using absorbable stitches. The wounds were cleaned and dried, and sterile bandages were placed. All needle, sponge, and instrument counts were correct at the end of the case. The patient tolerated the procedure well, was extubated, and will be taken to the recovery room in stable condition. We will follow his pulses closely postoperatively. The patient tolerated the procedure well.