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Thread: Please help code this note.I am new to this and any help would be apprecicated.

  1. #1
    Join Date
    Apr 2007

    Question Please help code this note.I am new to this and any help would be apprecicated.

    AAPC: Back to School
    Please help me with this op note:

    The patient was brought to the operating room an placed in the supine position. General endotracheal anesthesia was induced. The lower abdomen, both groins and both lower extremities were prepped to the knee and draped in standard fashion. A vertical incision was made over the left femoral artery. This was deepened through the subcutaneous tissue. The fascia and lymphatic tissue were then elevated from medial to lateral to minimize trauma to the lymphatic tissue. The superficial femoral and profunda femoris were dissected free and isolated with silastic vessel loops. The common femoral artery was not visualized in the operative field due to high bifurcation.

    Attention was then turned to the right groin where a vertical incision was made over the right femoral artery incorporating the scar from a previous proximal to distal bypass. The common femoral and superficial femoral arteries were dissected and isolated with silastic vessel loops. This dissection was carried out very carefully secondary to the amount of scar tissue around these vessels encountered after the previous surgery. The tunnel was then created subcutaneously between both groin incisions and a Gore-Tex propaten ring enforced graft was passed through the tunnel. The patient was given 6000 units of intravenous helparin and 5 minutes were allowed to elapse after heparin administration. After this time had elapsed the common femoral and superficial femoral arteries were clamped on the donor site using vascular clamps. An arteriotomy was performed in the common femoral artery obliquely towards the profunda femoris using an 11 blade scalpel and extended using Potts scissors. The end of the graft was fashioned to fit the arteriotomy and an anastomosis was constructed between the end of the graft and the site of the femoral artery using a running #5-0 prolene in a continuous fashion. Before completing the ananstomosis the lumen was irrigated and profunda femoris and superficial femoral arteries were allowed to back-bleed. The common femoral artery was allowed to forward bleed. The anastomosis has been completed and blood was allowed to flow into the donor leg. The anastomotic site was thoroughly irrigated and wrapped in surgical and a wet sponge placed in the groin wound prior to removal of vascular clamps. An atraumatic vascular clamp had been applied to the graft to occlude blood flow. The recipient profunda femoris was prepped in the same fashion as the donor side with vascular clamps and an arteriotomy was made in the profunda femoris. An anastomosis was then constructed between the end of the graft after removing rings such that a suitable graft length was obtained. The anastomosis was created using a running continuous suture of #5-0 prolene. Again prior to completion of the anastomosis, blood was allowed to back bleed from the profunda femoris and forward bleed from the proximal profunda femoris and the graft was allwed to forward bleed as well. The lumen was irigated and the anastomosis was completed. Again, the wound was irrigated with sterile saline and the anastomosis wrappped in sugicell. Blood flow in the distal profunda femoris on the right and the superficial frmoral on the left was checked by both palpation and doppler probe. Hemostasis was then achieved in both groins using electrocautery as needed. Both groins were closed in 3 layers. The first with a running #3-0 vicryl closing fascia over the anastomosis. The second layer closing subcutaneous tissue with the same continuous running suture and the skin in both groins were closed with a running subcuticular suture of #4-0 vicryl. Pulses were checked in both the donor and recipient legs postoperatively, The skin closure was secured with demabond in both groins. The patient tolerated the procedure well was extubated and awakened. Pulse exam was double check in both lowere extremities and noted to be stable. The patient was taken to the post anesthesia care unit in stable condition.

    Any help really would be appreciated. Brenda

  2. #2
    Join Date
    Apr 2007


    Sounds like a fem-fem bypass but I can't tell from the op note which fem to which fem the graft is attached to.

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