TWilliam2019
Guru
1. Revision of right femoral to tibioperoneal trunk vein graft with thromboendarterectomy of vein graft with patch angioplasty
2. Code for reoperative surgery right femoral vessels greater than 2 years
3. Color duplex ultrasound interrogation of right femoral to tibial peroneal trunk vein graft pre and post thromboendarterectomy with patch angioplasty.
Oblique oriented incision was made in the right groin and proximal thigh area. Dissection in the right femoral area was performed until I located the proximal vein graft. The vein graft was then exposed for about 10 to 15 cm. The area of stenosis was palpable in the graft but was confirmed with color duplex scanning. Patient systemically heparinized. The vein graft was controlled proximally just distal to the proximal anastomosis. Distally was controlled below the area of stenosis utilizing delicate vascular clamps. Longitudinal venotomy was performed in the bypass graft. Stenosis was identified and thromboendarterectomy of some valve leaflet remnants was performed to make additional room in the posterior wall of the vein graft. Patch angioplasty was then performed with an 8 mm wide bovine patch sewn in with 6-0 Prolene suture. Sufficient patch was sewn into bridge the area of the stenosis comfortably. The stenosis was consistent with intimal hyperplasia.
Upon completion of the suture line flow was restored. Pulse improved significantly below the area of the stenosis. Color-flow duplex exam was completed which showed good result with no residual significant stenosis. Hemostasis was ensured.
Incision was then closed with 3-0 PDS and 4 Monocryl.
? 35875
2. Code for reoperative surgery right femoral vessels greater than 2 years
3. Color duplex ultrasound interrogation of right femoral to tibial peroneal trunk vein graft pre and post thromboendarterectomy with patch angioplasty.
Oblique oriented incision was made in the right groin and proximal thigh area. Dissection in the right femoral area was performed until I located the proximal vein graft. The vein graft was then exposed for about 10 to 15 cm. The area of stenosis was palpable in the graft but was confirmed with color duplex scanning. Patient systemically heparinized. The vein graft was controlled proximally just distal to the proximal anastomosis. Distally was controlled below the area of stenosis utilizing delicate vascular clamps. Longitudinal venotomy was performed in the bypass graft. Stenosis was identified and thromboendarterectomy of some valve leaflet remnants was performed to make additional room in the posterior wall of the vein graft. Patch angioplasty was then performed with an 8 mm wide bovine patch sewn in with 6-0 Prolene suture. Sufficient patch was sewn into bridge the area of the stenosis comfortably. The stenosis was consistent with intimal hyperplasia.
Upon completion of the suture line flow was restored. Pulse improved significantly below the area of the stenosis. Color-flow duplex exam was completed which showed good result with no residual significant stenosis. Hemostasis was ensured.
Incision was then closed with 3-0 PDS and 4 Monocryl.
? 35875