luvmyphx
Contributor
Please help with coding this surgery, thanks
POSTOPERATIVE DIAGNOSIS: Complex infrarenal abdominal aortic aneurysm with highly angulated neck, short neck, and tortuous iliac arteries.
*
OPERATION PERFORMED: Endovascular repair of abdominal aortic aneurysm with open femoral exploration bilaterally, placement of sheaths and catheters into the aorta and iliac arteries, multiple angiograms, aortogram with runoff, placement of main body Gore Excluder on the right with a 28 x 14 x 18 graft, subsequent contralateral limb placement on the left with a 16 x 16 x 13 left limb, and an extension limb on the left of 16 x 12 x 14 cm, and a further extension limb on the right of 16 x 18 x 10 cm and 2 proximal cuffs, 28.5 x 28.5 x 3 cm x2, completion angiogram and subsequent repair of common femoral arteries.
DESCRIPTION OF OPERATION: The patient was placed on the operating room table in the supine position, and after adequate general endotracheal anesthesia, the abdomen and both legs were prepped and draped in the usual sterile fashion. Incisions were made overlying the common femoral arteries bilaterally. It was taken down through skin and subcutaneous tissue. Hemostasis was obtained with the Bovie electrocautery. Both common femoral arteries were dissected out proximally and distally, and the superficial femoral and femoral profunda arteries were dissected out on the right. The right common femoral artery was slightly aneurysmal. Under direct vision the femoral arteries were cannulated and the sheaths placed. There was significant tortuosity of the external iliac and common iliac arteries bilaterally, and this required a fair amount of manipulation just to pass the catheters up the iliac arteries. A guidewire was placed up the left, and a marker pigtail was placed up the right above the level of the aneurysm with some difficulty. Angiogram was obtained. The amount of angulation of the aorta was fairly impressive. It was elected to put the main body on the right, and it was introduced on the right. Multiple angiograms were obtained in order to place the balloon just at the level of the left renal artery. We actually pulled the stiff guidewire back so that it would conform more to the significant angulation of the aorta. The main body was placed but not completely deployed. The left contra limb was cannulated, however, this required utilization of the 7 x 45 Ansel Modification 1 sheath. Once this was cannulated, a stiff wire was placed up the left, and a Q50 PLUS balloon was utilized to form the proximal graft. The left prosthesis limbs were then placed. The distance was significant, and it was elected to bridge the gate down to the external iliac artery with 2 grafts. A proximal 16 x 16 x 13.5 cm graft was placed, followed by a 16 x 12 x 14 cm graft down to below the level of the takeoff of the internal iliac artery which was chronically occluded. In a similar fashion, the main body and right ipsi-limb of the graft were deployed. It was noted that an extension would be needed on the right as well. For this reason, a 16 x 18 x 10 cm ipsi-limb extender was placed. Balloon angioplasty forming was performed throughout the graft and into the limbs. Completion angiogram was obtained, and it was noted that proximal cuffs were needed. Two proximal cuffs were placed. The first cuff was a 28.5 x 28.5 mm x 3 cm graft. It bridged nicely and sat down at the level of the left renal artery. It also nicely formed the angle into the significantly angulated aorta. However, it was elected to go ahead and place a second cuff just distal to that to make sure that the main body was well supported. This was done in a similar fashion. Again, balloon forming angioplasty was performed, a completion angiogram obtained in multiple views, and there was no evidence of endoleak. The sheaths and the wires were removed. The arteriotomies irrigated and flushed with heparinized saline. They were then reapproximated transversely with running 6-0 Prolene suture. The wound was then irrigated and inspected. It was noted hemostasis was intact. The wounds were then closed in multiple layers with 3-0 Vicryl in the subcutaneous tissue and 4-0 Monocryl subcuticular closure on the skin, and sterile dressing applied. The patient tolerated the procedure well, having minimal blood loss; no blood was replaced. After the operation, all sponge, needle, and instrument counts were correct x2.
POSTOPERATIVE DIAGNOSIS: Complex infrarenal abdominal aortic aneurysm with highly angulated neck, short neck, and tortuous iliac arteries.
*
OPERATION PERFORMED: Endovascular repair of abdominal aortic aneurysm with open femoral exploration bilaterally, placement of sheaths and catheters into the aorta and iliac arteries, multiple angiograms, aortogram with runoff, placement of main body Gore Excluder on the right with a 28 x 14 x 18 graft, subsequent contralateral limb placement on the left with a 16 x 16 x 13 left limb, and an extension limb on the left of 16 x 12 x 14 cm, and a further extension limb on the right of 16 x 18 x 10 cm and 2 proximal cuffs, 28.5 x 28.5 x 3 cm x2, completion angiogram and subsequent repair of common femoral arteries.
DESCRIPTION OF OPERATION: The patient was placed on the operating room table in the supine position, and after adequate general endotracheal anesthesia, the abdomen and both legs were prepped and draped in the usual sterile fashion. Incisions were made overlying the common femoral arteries bilaterally. It was taken down through skin and subcutaneous tissue. Hemostasis was obtained with the Bovie electrocautery. Both common femoral arteries were dissected out proximally and distally, and the superficial femoral and femoral profunda arteries were dissected out on the right. The right common femoral artery was slightly aneurysmal. Under direct vision the femoral arteries were cannulated and the sheaths placed. There was significant tortuosity of the external iliac and common iliac arteries bilaterally, and this required a fair amount of manipulation just to pass the catheters up the iliac arteries. A guidewire was placed up the left, and a marker pigtail was placed up the right above the level of the aneurysm with some difficulty. Angiogram was obtained. The amount of angulation of the aorta was fairly impressive. It was elected to put the main body on the right, and it was introduced on the right. Multiple angiograms were obtained in order to place the balloon just at the level of the left renal artery. We actually pulled the stiff guidewire back so that it would conform more to the significant angulation of the aorta. The main body was placed but not completely deployed. The left contra limb was cannulated, however, this required utilization of the 7 x 45 Ansel Modification 1 sheath. Once this was cannulated, a stiff wire was placed up the left, and a Q50 PLUS balloon was utilized to form the proximal graft. The left prosthesis limbs were then placed. The distance was significant, and it was elected to bridge the gate down to the external iliac artery with 2 grafts. A proximal 16 x 16 x 13.5 cm graft was placed, followed by a 16 x 12 x 14 cm graft down to below the level of the takeoff of the internal iliac artery which was chronically occluded. In a similar fashion, the main body and right ipsi-limb of the graft were deployed. It was noted that an extension would be needed on the right as well. For this reason, a 16 x 18 x 10 cm ipsi-limb extender was placed. Balloon angioplasty forming was performed throughout the graft and into the limbs. Completion angiogram was obtained, and it was noted that proximal cuffs were needed. Two proximal cuffs were placed. The first cuff was a 28.5 x 28.5 mm x 3 cm graft. It bridged nicely and sat down at the level of the left renal artery. It also nicely formed the angle into the significantly angulated aorta. However, it was elected to go ahead and place a second cuff just distal to that to make sure that the main body was well supported. This was done in a similar fashion. Again, balloon forming angioplasty was performed, a completion angiogram obtained in multiple views, and there was no evidence of endoleak. The sheaths and the wires were removed. The arteriotomies irrigated and flushed with heparinized saline. They were then reapproximated transversely with running 6-0 Prolene suture. The wound was then irrigated and inspected. It was noted hemostasis was intact. The wounds were then closed in multiple layers with 3-0 Vicryl in the subcutaneous tissue and 4-0 Monocryl subcuticular closure on the skin, and sterile dressing applied. The patient tolerated the procedure well, having minimal blood loss; no blood was replaced. After the operation, all sponge, needle, and instrument counts were correct x2.