TWilliam2019
Guru
Right axillary artery cutdown with creation of 8 mm Hemashield graft conduit ?34716
Operative findings:
The axillary artery was small and deep in the infraclavicular region. The 8 mm Hemashield graft was anastomosed to the artery. There was severe vascular bleeding and oozing coming from the suture line and needle holes. The patient's ACT was profoundly elevated. Following the graft insertion the patient developed hemodynamic instability requiring significant blood pressure support including Levophed. Eventually the patient he requested requiring defibrillation. CPR was performed transiently elevated and the blood pressure returned to satisfactory levels. Patient eventually developed gastrointestinal bleeding was identified and placement NG tube. Eventually the patient arrested multiple times requiring extended CPR. Other findings are described in the cardiology note. The patient passed away in the catheter lab.
Operation in detail:
With the patient already in the catheterization lab intubated the operating table the entire left infraclavicular region was prepped and draped in a sterile manner. The patient had awoken following his earlier cardiac arrest and follow commands. General anesthesia was administered. A left infraclavicular incision was made and deepened down through the skin and soft tissues. The pectoralis major muscle was divided. Self-retaining retractor was inserted. The axillary artery wasn't dissected out and encircled proximally and distally with vessel loops. The patient had a satisfactory ACT greater than 400 seconds. The axillary artery was controlled proximally and distally with vessel loops and vascular clamps. A longitudinal arteriotomy was performed and the 8 mm Hemashield graft was beveled beveled and sewn in end-to-side manner to the axillary artery using running 7-0 Prolene. There was significant oozing coming from the needle holes at the anastomosis stat occasions were placed around the anastomosis. Eventually the patient's hemodynamic condition deteriorated as described above. It was not possible to consider exchange of the Impala CP device with a 5.5 device due to the profound hemodynamic instability and multiple arrest. The patient was pronounced dead as described in cardiology note. The graft was trimmed and closed and the wound was closed sutures.
Operative findings:
The axillary artery was small and deep in the infraclavicular region. The 8 mm Hemashield graft was anastomosed to the artery. There was severe vascular bleeding and oozing coming from the suture line and needle holes. The patient's ACT was profoundly elevated. Following the graft insertion the patient developed hemodynamic instability requiring significant blood pressure support including Levophed. Eventually the patient he requested requiring defibrillation. CPR was performed transiently elevated and the blood pressure returned to satisfactory levels. Patient eventually developed gastrointestinal bleeding was identified and placement NG tube. Eventually the patient arrested multiple times requiring extended CPR. Other findings are described in the cardiology note. The patient passed away in the catheter lab.
Operation in detail:
With the patient already in the catheterization lab intubated the operating table the entire left infraclavicular region was prepped and draped in a sterile manner. The patient had awoken following his earlier cardiac arrest and follow commands. General anesthesia was administered. A left infraclavicular incision was made and deepened down through the skin and soft tissues. The pectoralis major muscle was divided. Self-retaining retractor was inserted. The axillary artery wasn't dissected out and encircled proximally and distally with vessel loops. The patient had a satisfactory ACT greater than 400 seconds. The axillary artery was controlled proximally and distally with vessel loops and vascular clamps. A longitudinal arteriotomy was performed and the 8 mm Hemashield graft was beveled beveled and sewn in end-to-side manner to the axillary artery using running 7-0 Prolene. There was significant oozing coming from the needle holes at the anastomosis stat occasions were placed around the anastomosis. Eventually the patient's hemodynamic condition deteriorated as described above. It was not possible to consider exchange of the Impala CP device with a 5.5 device due to the profound hemodynamic instability and multiple arrest. The patient was pronounced dead as described in cardiology note. The graft was trimmed and closed and the wound was closed sutures.