DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Moderately severe extracranial carotid artery disease.
2. Right subclavian artery occlusion.
3. Hypertension.
4. Coronary artery disease.
POSTOPERATIVE DIAGNOSES:
1. Moderately severe extracranial carotid artery disease.
2. Right subclavian artery occlusion.
4. Coronary artery disease.
5. History of total hip replacements.
OPERATION PERFORMED: Left carotid endarterectomy with Finesse Dacron patch angioplasty.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and sterilely prepped and draped in the supine position. Preoperative prophylactic antibiotics were administered and multiple monitoring lines were placed.
An incision was made along the anterior border of the sternomastoid muscle in the left neck. The skin and subcutaneous tissue were sharply incised. The dissection was carried down to the platysma with the use of electrocautery. Gelpi retractors were placed for adequate exposure. The omohyoid muscle was divided between ties of 2-0 silk to give exposure to the common carotid artery. The vagus nerve was seen, identified and preserved. The dissection was then carried out distally to where the superior thyroid, external carotid and internal carotid were exposed and in turn encircled with vessel loops. The patient was systemically heparinized with 6000 units of heparin and adequate time for circulation was allowed for. The internal, external and common carotid arteries were in turn cross-clamped.
An arteriotomy was created with a #11 blade and extended with Potts scissors from the common carotid artery out the internal carotid artery. Findings at this time are coral reef plaque in the carotid bulb that extended into the internal carotid artery producing an 85% stenosis of the left internal carotid artery. A 3.5 mm shunt was introduced into the internal carotid artery and allowed to back bleed. It was secured in the common carotid artery as well. No EEG abnormalities were noted during this or any subsequent maneuvers. An endarterectomy was then commenced on the carotid bulb and brought back proximally. The plaque was divided with the use of the Strully scissors. An eversion endarterectomy was done of the external carotid artery. The plaque was then found to feather off quite nicely in the internal carotid artery. No distal or interval packing sutures were required. A portion of Finesse Dacron was then sewn as an onlay patch angioplasty with running continuous suture of 6-0 Prolene. The shunt was then cross-clamped and removed. The remainder arteriotomy was completed. All air and debris were allowed to flush out the external carotid artery. The internal carotid artery was opened after approximately 6 cardiac cycles. Sterile Doppler was used to ascertain that there was excellent flow present in the internal carotid artery. The patient’s heparin was then reversed with 50 mg protamine IV.
All wounds were then copiously irrigated with normal saline and Kantrex. The neck was then closed in layers with 2-0 and 3-0 Vicryl. The skin was reapproximated with running subcuticular 4-0 undyed Vicryl. Benzoin and Steri-Strips were applied to the wound. Needle and sponge counts were correct x2. The patient was then awakened and transported to the recovery room in stable condition.
