DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Occluded right radial artery at the wrist.
2. Severe ischemia with discoloration of the thumb and index finger of the right hand.
PROCEDURES PERFORMED:
1. Right radial artery exploration.
2. Embolectomy, right radial artery with patch angioplasty.
3. Exploration of right antecubital fossa.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
COMPLICATIONS: None.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old male who presented with pain involving the right thumb and index fingers. The patient had significant discoloration of the index finger from the mid phalanx to the tip and had a patchy area of ischemia involving the plantar aspect of the thumb. The patient had ischemic changes involving the distal aspect of the thumb and was admitted to the hospital and underwent an angiogram of the right upper extremity. This showed an occlusion of the radial artery from the wrist to the elbow, and the patient also had an occlusion of the first and second digital vessels. The patient was recommended to undergo exploration of the radial artery for embolectomy and was agreeable. Informed consent was obtained.
PROCEDURE FINDINGS: Thrombosis of the radial artery at the wrist.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed on the table in the supine position. General endotracheal anesthesia was given to the patient without any problem. The right arm was prepped and draped in the usual sterile fashion.
A longitudinal incision was made along the wrist. This incision was carried down through the skin and subcutaneous tissue. The radial artery was identified. A clot was noted in the radial artery. The radial artery did not have any significant palpable pulse. The patient was given 3000 units of heparin and the radial artery was clamped superiorly. An 11 blade was used to make a 1 cm long arteriotomy of the radial artery at the wrist. A fresh clot was noted at the arteriotomy site. The clot was removed. No back-bleeding was noted. A 3-French Fogarty was introduced into the distal radial artery and embolectomy of that artery was performed. There was good back-bleeding from the hand. The upper radial artery was flushed with adequate blood flow from the top. No injury was noted to the radial artery. The wrist was explored for suitable vein for a patch; we were not able to locate one. Attention was then directed to the antecubital fossa. A small incision was made at the antecubital fossa and a 1.5 cm vein was identified. It was doubly ligated and divided.
The subcutaneous tissue was closed with 3-0 Vicryl. The skin was closed with running 4-0 Vicryl. Attention was then directed to the arteriotomy. The vein was opened; it was spatulated. The vein was sutured into the radial artery with 7-0 Prolene suture in a running fashion and 2 sutures were used, 1 for the heel, 1 for the toe. Flow was restored to the right hand without any problem. Doppler probe was used to insonate the distal radial artery with adequate flow. The subcutaneous tissue was then closed with 3-0 Vicryl. The skin was closed with 4-0 Vicryl. Hemostasis was optimal. Dry dressing was applied to the wrist and the antecubital fossa. The patient tolerated the procedure well, was extubated in the operating room and sent to the recovery room in stable condition.
