How would one code a jump graft?
Physician statse Revision of a right femoral to posterior
tibial artery bypass graft with a jump graft to the peroneal
artery. We used reversed great saphenous vein translocated.
Any help would be greatly appreciated
OP REPORT:
DESCRIPTION OF PROCEDURE: In the operating room, he received
general anesthetic with endotracheal tube intubation. A Foley
catheter was inserted. The left groin was clipped and prepped
with ChloraPrep and sterilely draped. A time-out was performed.
He received intravenous antibiotics.
I made an incision in the left groin and I harvested the great
saphenous vein from the saphenofemoral junction down to the
proximal thigh. Two additional incisions were required to
harvest this vein. About 10 cm down bifurcated into two and I
did follow that down for several cm. Branches were ligated and
the vein was harvested from the saphenofemoral junction with an
over-sewing of 5-0 Prolene. The vein was then flushed and hand
off the table. Incisions were then closed with 2-0 and 3-0
Vicryl and 4-0 Monocryl.
The patient was then placed on this different operating room
table in a prone position. The leg was then prepped with
Hibiclens and ChloraPrep and sterilely draped. I made an
incision in the ______ between the tibial edge and in the
fibular edge down through skin and subcutaneous tissue. I
worked along the medial aspect of the fibula removing the muscle
attachments. I kept going deep along the medial edge and came
______ initially the peroneal vein and then worked to identify
the peroneal artery. We got out about 4 cm or so segment of the
peroneal artery. It was quite small proximally and it did
improve distally as far as size. We gained circumferential
control with vessel loops.
His previously placed bypass graft was over the medial aspect of
his calf and I made an incision over that slightly above where
we were with the peroneal vein so that there would be a little
bit of a slant to the bypass graft. The previously placed vein
graft was readily palpable and easily identifiable and we gained
circumferential exposure with sharp dissection. A vessel loop
was placed around this. I then made a tunnel between the deep
and superficial posterior compartment and marked it with a
Dacron tape. The vein was then dilated. The valves were then
stripped. We then reversed the vein. The patient was
anticoagulated with 6000 units of heparin and an additional dose
was given some time later. Clamped the artery, created an
arteriotomy. There was some clot along wall, but there was back
bleeding noted from the artery. We then sewed the hood of the
vein graft using 7-0 Prolene down on to the artery. We did
remove the clamps on the artery and we did have backbleeding and
I was able to flush through the graft. Additional sutures along
the suture line required interrupted 7-0 Prolene x3. I then
marked the vein and passed it through the tunnel. Attention was
then turned to the original bypass graft, which was clamped and
an arteriotomy was created on the posterolateral aspect. I
spatulated the vein graft and performed an end vein graft to
side artery graft anastomosis using 7-0 Prolene suture. Before
completion, we did allow for antegrade and retrograde bleeding
and flushing. We completed this anastomosis. We maintained
pulse within the original bypass graft and then also within the
graft itself within a new bypass graft. Signals were obtained
by Doppler distally. We had adequate hemostasis after a minute
an additional suture was placed in the peroneal suture line. We
irrigated and closed with 3-0 Vicryl and 4-0 nylon suture.
Sponge and needle counts were correct. Blood loss was
approximately 75 cc and I was present and scrubbed for the
entire procedure.
Physician statse Revision of a right femoral to posterior
tibial artery bypass graft with a jump graft to the peroneal
artery. We used reversed great saphenous vein translocated.
Any help would be greatly appreciated
OP REPORT:
DESCRIPTION OF PROCEDURE: In the operating room, he received
general anesthetic with endotracheal tube intubation. A Foley
catheter was inserted. The left groin was clipped and prepped
with ChloraPrep and sterilely draped. A time-out was performed.
He received intravenous antibiotics.
I made an incision in the left groin and I harvested the great
saphenous vein from the saphenofemoral junction down to the
proximal thigh. Two additional incisions were required to
harvest this vein. About 10 cm down bifurcated into two and I
did follow that down for several cm. Branches were ligated and
the vein was harvested from the saphenofemoral junction with an
over-sewing of 5-0 Prolene. The vein was then flushed and hand
off the table. Incisions were then closed with 2-0 and 3-0
Vicryl and 4-0 Monocryl.
The patient was then placed on this different operating room
table in a prone position. The leg was then prepped with
Hibiclens and ChloraPrep and sterilely draped. I made an
incision in the ______ between the tibial edge and in the
fibular edge down through skin and subcutaneous tissue. I
worked along the medial aspect of the fibula removing the muscle
attachments. I kept going deep along the medial edge and came
______ initially the peroneal vein and then worked to identify
the peroneal artery. We got out about 4 cm or so segment of the
peroneal artery. It was quite small proximally and it did
improve distally as far as size. We gained circumferential
control with vessel loops.
His previously placed bypass graft was over the medial aspect of
his calf and I made an incision over that slightly above where
we were with the peroneal vein so that there would be a little
bit of a slant to the bypass graft. The previously placed vein
graft was readily palpable and easily identifiable and we gained
circumferential exposure with sharp dissection. A vessel loop
was placed around this. I then made a tunnel between the deep
and superficial posterior compartment and marked it with a
Dacron tape. The vein was then dilated. The valves were then
stripped. We then reversed the vein. The patient was
anticoagulated with 6000 units of heparin and an additional dose
was given some time later. Clamped the artery, created an
arteriotomy. There was some clot along wall, but there was back
bleeding noted from the artery. We then sewed the hood of the
vein graft using 7-0 Prolene down on to the artery. We did
remove the clamps on the artery and we did have backbleeding and
I was able to flush through the graft. Additional sutures along
the suture line required interrupted 7-0 Prolene x3. I then
marked the vein and passed it through the tunnel. Attention was
then turned to the original bypass graft, which was clamped and
an arteriotomy was created on the posterolateral aspect. I
spatulated the vein graft and performed an end vein graft to
side artery graft anastomosis using 7-0 Prolene suture. Before
completion, we did allow for antegrade and retrograde bleeding
and flushing. We completed this anastomosis. We maintained
pulse within the original bypass graft and then also within the
graft itself within a new bypass graft. Signals were obtained
by Doppler distally. We had adequate hemostasis after a minute
an additional suture was placed in the peroneal suture line. We
irrigated and closed with 3-0 Vicryl and 4-0 nylon suture.
Sponge and needle counts were correct. Blood loss was
approximately 75 cc and I was present and scrubbed for the
entire procedure.