Wiki Endovascular stent repair of AAA

KoBee

Expert
Messages
388
Best answers
0
I am super stuck :confused: I keep leaning towards 34708 but something tells me I'm missing something... Any one want to take a shot and try to help please!


PREOPERATIVE DIAGNOSIS:
Abdominal aortic aneurysm.

POSTOPERATIVE DIAGNOSIS:
Abdominal aortic aneurysm.

PROCEDURE:
Endovascular stent repair of abdominal aortic aneurysm.


OPERATIVE PROCEDURE:
The patient was brought to the operating room, placed on the operating table.
After adequate general anesthesia, the patient's groin area was shaved and both
legs were prepped from the toes all the way up to the umbilicus. The patient
was then draped in the usual sterile manner. Bilateral curvilinear groin
incisions were then made and dissection was carried down to the femoral
vessels. On the right side, the common femoral artery was identified and it
was dissected free circumferentially and encircled with a vessel loop. The
patient had enough common femoral artery here that a second vessel loop could
be placed distally such that a segment measuring about 2.5 cm exposed. On the
right side, the common femoral, superficial femoral, profunda vessels were all
dissected free circumferentially and encircled with vessel loops. On each side
using a Cook needle, guidewire was inserted into the femoral vessels followed
by a 5-French sheath. This was all done under fluoroscopic guidance. Once
this was done, we went ahead and placed our Glidewire up further proximally
through the iliacs, through the aneurysm up into the proximal descending
abdominal aorta. Again, all under fluoroscopic guidance. On the left side, a
Kumpe sheath was inserted into the artery. The Glidewire was replaced with a
stiff Bentson wire and over this, we went ahead and passed our main body
device, which was an Endurant II 25 x 14 x 103. The device was positioned into
place, but not deployed. On the right side, we went ahead and placed a pigtail



catheter and an on-table angiogram was then performed. The left renal artery
was identified. The patient had a nephrectomy on the right side. The graft
was then gradually deployed angling the gate more anterolaterally to the left.
The main body was deployed until the gate opened. At this point, the pigtail
catheter on the right side was then removed over a guidewire and replaced with
a Kumpe sheath. Attempt was made to cannulate the gate without success, an
angling sheath had to be then used to cannulate the gate successfully. The
guidewire was then passed up through the gate. Angling sheath was then
removed, and a sheath was then placed over the guidewire as well as a pigtail
catheter and an on-table angiogram was then performed. The distance from our
bifurcation to the iliac takeoff was measured, it appeared that a 16 x 16 x 124
length catheter would be appropriate here and the pigtail catheter and sheath
was then removed over wire and the right limb extension device was then
inserted and then, deployed successfully down to the level of the internal
iliac takeoff on the right. Similarly on the right side, a similar procedure
was performed. It should be noted that our suprarenal anchoring device had
already been deployed and the remaining portion of our graft on the left side
was deployed. The device was then removed and replaced with a sheath. Once
again, a pigtail catheter was also inserted and once again an on-table
angiogram was performed on the left side, distance to our internal iliac
takeoff was measured and it appeared that a 16 x 16 x 93 limb would be the
appropriate size. The pigtail catheter removed and our device was then
threaded over the wire and through our sheath up to our main body graft. The
device was then deployed successfully down to the internal iliac takeoff. At
this point, 2 Reliant balloons were inserted up each limb and inflated
sequentially down the entire length of the aortic graft and the limbs. Once
this was done, a completion aortogram was then performed. This showed good
seal without any endoleaks or no kinks within the graft. At this point, the
sheaths and wires were all removed and the arteriotomies in our femoral vessels
were closed using interrupted 6-0 Prolene sutures. The wounds were irrigated
and aspirated. The wounds were closed in layers with deep layers of 2-0
Vicryl. The skin was closed using 4-0 Monocryl using a subcuticular stitch and
dressed with Steri-Strips, 4x4 gauze, and tape. The patient tolerated the
procedure well without any complications. Anesthesia was reversed. The
patient returned to the recovery room in satisfactory condition. In the
recovery room, the patient was noted to have palpable pedal pulses as he did
preoperatively. Total contrast used was 70 cc and our fluoro time was 34
minutes and 51 seconds.
 
Top