kcosalter
New
Good Morning All!
I'm struggling with this OP report today, I could use ANY opinions or advice.
The common femoral artery itself was large and a little bit bulbous. The patient was systemically heparinized to the profunda femoris as well as the distal external iliac artery were clamped. A profunda clamp was used for the profunda artery with smaller branches controlled with red vessel loops and the distal external iliac was controlled with a Derra clamp. I then used an 11 blade to cut through the middle of the preexisting Gore patch that was on the common femoral artery. There was fresh thrombus that we took of the entire lumen of the common femoral artery. I was able to remove all of this thrombus burden. Using a #4 embolectomy catheter, I passed it down the superficial femoral artery and after about 3 passes. Finally, we returned a large amount of thrombus. There was then good backbleeding from the superficial femoral artery. I then passed the Fogarty embolectomy down the profunda. There was no additional clot burden there and there was good backbleeding, so that was re-controlled with a profunda clamp. I then checked my inflow and I did not have good inflow. The embolectomy catheter was passed proximally up the iliac artery. I got small pieces of plaque, but no fresh thrombus; however, as I pulled a Fogarty balloon down the iliac, it did seem to get caught up as though there was a significant stenosis at the top edge of the preexisting patch. I extended my arteriotomy a bit more proximally and I did find significant intimal hyperplasia there and it did look like there was an inflow stenosis, it made me wonder if this was the cause of the artery thrombosing initially. I ended up sharply excise in most of that preexisting Gore patch. An extensive endarterectomy was performed from the distal external iliac artery down to the distal common femoral artery, I took great care to make sure that the origins of both the superficial femoral artery and the profunda were free and clear of any residual plaque. I then chose a 2 x 9 cm bovine pericardial patch essentially the entire length of that was required to patch the endarterectomized segment of the artery. This was done with a running 5-0 Prolene suture. Prior to the completion of the anastomosis, all branches were backbled. I did not have good bleeding from the superficial femoral artery until the #4 embolectomy catheter was passed down it again. At this time, I withdrew almost a cast from it and there was now robust backbleeding. Everything was flushed with heparinized saline. The anastomosis was complete.
To me it sounds like it was performed on all Iliac, Common Fem, Superficial Fem, Profunda. I don't know if this OP falls under an iliofemoral, or Common Femoral..
Thank you!!
I'm struggling with this OP report today, I could use ANY opinions or advice.
The common femoral artery itself was large and a little bit bulbous. The patient was systemically heparinized to the profunda femoris as well as the distal external iliac artery were clamped. A profunda clamp was used for the profunda artery with smaller branches controlled with red vessel loops and the distal external iliac was controlled with a Derra clamp. I then used an 11 blade to cut through the middle of the preexisting Gore patch that was on the common femoral artery. There was fresh thrombus that we took of the entire lumen of the common femoral artery. I was able to remove all of this thrombus burden. Using a #4 embolectomy catheter, I passed it down the superficial femoral artery and after about 3 passes. Finally, we returned a large amount of thrombus. There was then good backbleeding from the superficial femoral artery. I then passed the Fogarty embolectomy down the profunda. There was no additional clot burden there and there was good backbleeding, so that was re-controlled with a profunda clamp. I then checked my inflow and I did not have good inflow. The embolectomy catheter was passed proximally up the iliac artery. I got small pieces of plaque, but no fresh thrombus; however, as I pulled a Fogarty balloon down the iliac, it did seem to get caught up as though there was a significant stenosis at the top edge of the preexisting patch. I extended my arteriotomy a bit more proximally and I did find significant intimal hyperplasia there and it did look like there was an inflow stenosis, it made me wonder if this was the cause of the artery thrombosing initially. I ended up sharply excise in most of that preexisting Gore patch. An extensive endarterectomy was performed from the distal external iliac artery down to the distal common femoral artery, I took great care to make sure that the origins of both the superficial femoral artery and the profunda were free and clear of any residual plaque. I then chose a 2 x 9 cm bovine pericardial patch essentially the entire length of that was required to patch the endarterectomized segment of the artery. This was done with a running 5-0 Prolene suture. Prior to the completion of the anastomosis, all branches were backbled. I did not have good bleeding from the superficial femoral artery until the #4 embolectomy catheter was passed down it again. At this time, I withdrew almost a cast from it and there was now robust backbleeding. Everything was flushed with heparinized saline. The anastomosis was complete.
To me it sounds like it was performed on all Iliac, Common Fem, Superficial Fem, Profunda. I don't know if this OP falls under an iliofemoral, or Common Femoral..
Thank you!!
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