nancygard1
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PREOPERATIVE DIAGNOSIS:
Ischemia left foot, peripheral vascular disease, thrombosed fern-fern graft.
POSTOPERATIVE DIAGNOSIS:
Ischemia left foot, peripheral vascular disease, thrombosed fern-fern graft.
OPERATION: Left femoral thromboendarterectomy with patch angioplasty and
profundoplasty with patch angioplasty and thrombectomy of fern-fern graft.
ASSISTANT/S: None.
ESTIMATED BLOOD LOSS: See below.
GROSS FINDINGS: See below.
ANY SPECIMENS REMOVED: See below.
DESCRIPTION OF THE PROCEDURE: The patient was brought to the operating
room and placed supine on the table. He was administered general
anesthetic. The patient was given preoperative antibiotics. Both groins
and leg on the left was prepped with Chloraprep and- draped in a standard
fashion. A cutdown was made over the left common femoral artery dissecting
free the common femoral, superficial femoral, and profunda femoris artery.
The profunda femoris was dissected down to the second branch. The fern-fern
graft was identified. The patient was on a heparin drip. We opened the
fern-fern graft and performed a thrombectomy with #3 and 4 Fogarty catheter.
We obtained good strong inflow and placed a graft clamp. We then opened to
the profunda femoris, the superficial femoral artery was occluded and we
performed a thromboendarterectomy of the femoral artery and the profunda.
We then patched out the fern-fern graft and the common femoral and profunda
femoris with a Bovine patch and running 6-0 Prolene. We then allowed
back-filling and opened. A very strong Doppler signal was noted in the
left profunda femoris artery and we assured hemostasis, 25 milligrams of
protamine sulfate and thrombin soaked Gelfoam. We irrigated and closed
using 2-0 Vicryl and subcuticular 4-0 Monocryl, Mastisol, and strips were
placed on the skin. The patient tolerated the procedure well and was
transferred to the Recovery Room in stable condition.
This is a 59-year-old male with severe peripheral vascular disease, status
_post fern-fern graft, previous balloon angioplasty of the profunda femoris.
He has had a number of failed fern-pop grafts. His foot had done well
living on basically his profunda and the fern-fern, however, the fern-fern shut
down due to outflow stenosis. At this time we went ahead and performed a
thrombectomy of th fern-fern graft and opened his profunda femoris and
patched it out. His foot became nice and pink. We felt that at this time
that there was really no need for a fern-pop bypass. The patient is an
amputee on the right side and has minimal or no ambulation.
Estimated blood loss was minimal. Specimens was plaque and clot. Sponge
and needle count were correct.
Ischemia left foot, peripheral vascular disease, thrombosed fern-fern graft.
POSTOPERATIVE DIAGNOSIS:
Ischemia left foot, peripheral vascular disease, thrombosed fern-fern graft.
OPERATION: Left femoral thromboendarterectomy with patch angioplasty and
profundoplasty with patch angioplasty and thrombectomy of fern-fern graft.
ASSISTANT/S: None.
ESTIMATED BLOOD LOSS: See below.
GROSS FINDINGS: See below.
ANY SPECIMENS REMOVED: See below.
DESCRIPTION OF THE PROCEDURE: The patient was brought to the operating
room and placed supine on the table. He was administered general
anesthetic. The patient was given preoperative antibiotics. Both groins
and leg on the left was prepped with Chloraprep and- draped in a standard
fashion. A cutdown was made over the left common femoral artery dissecting
free the common femoral, superficial femoral, and profunda femoris artery.
The profunda femoris was dissected down to the second branch. The fern-fern
graft was identified. The patient was on a heparin drip. We opened the
fern-fern graft and performed a thrombectomy with #3 and 4 Fogarty catheter.
We obtained good strong inflow and placed a graft clamp. We then opened to
the profunda femoris, the superficial femoral artery was occluded and we
performed a thromboendarterectomy of the femoral artery and the profunda.
We then patched out the fern-fern graft and the common femoral and profunda
femoris with a Bovine patch and running 6-0 Prolene. We then allowed
back-filling and opened. A very strong Doppler signal was noted in the
left profunda femoris artery and we assured hemostasis, 25 milligrams of
protamine sulfate and thrombin soaked Gelfoam. We irrigated and closed
using 2-0 Vicryl and subcuticular 4-0 Monocryl, Mastisol, and strips were
placed on the skin. The patient tolerated the procedure well and was
transferred to the Recovery Room in stable condition.
This is a 59-year-old male with severe peripheral vascular disease, status
_post fern-fern graft, previous balloon angioplasty of the profunda femoris.
He has had a number of failed fern-pop grafts. His foot had done well
living on basically his profunda and the fern-fern, however, the fern-fern shut
down due to outflow stenosis. At this time we went ahead and performed a
thrombectomy of th fern-fern graft and opened his profunda femoris and
patched it out. His foot became nice and pink. We felt that at this time
that there was really no need for a fern-pop bypass. The patient is an
amputee on the right side and has minimal or no ambulation.
Estimated blood loss was minimal. Specimens was plaque and clot. Sponge
and needle count were correct.