PROCEDURE PERFORMED: Percutaneous transluminal angioplasty, right femoropopliteal artery bypass and aortogram.
SURGEON: John Doe, MD
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 appropriate monitoring lights were placed.
A transverse incision was made in the right groin. The skin and subcutaneous tissues were sharply incised. The dissection was carried down to where the common femoral, superficial femoral, and profunda femoris arteries were dissected free. These were encircled with vessel loops. The popliteal artery was then dissected above the knee. The Kelly-Wick tunneling apparatus was used to pass a portion of 6 mm Gore-Tex.
The left common femoral artery was cannulated under fluoroscopy with Cournand needle and a #7 French introducer was placed. The patient was then systemically heparinized with 8500 units of heparin. Adequate time for circulation was allowed. A 0.35 guidewire was then placed into the abdominal aorta under fluoroscopy.
An aortogram with runoff into the common femoral artery was obtained. There was noted to be, with oblique views, a 50-60% stenosis over the left external iliac artery. An 8 x 24 mm Genesis stent was brought to profile at 8 atmospheres. Followup angiogram showed an excellent technical result with no residual significant stenosis.
An arteriotomy was created in the femoral artery with a #11 blade and extended with the Potts scissors, and end-to-side anastomosis was then created here with running continuous sutures of #5-0 Prolene. An arteriotomy was created on the popliteal artery with a #11 blade and extended with the Potts scissors, and end-to-side anastomosis was then created here with running continuous sutures of #6-0 Prolene.
The graft was opened and found to be hemostatic. The patient was found to have palpable pulses in the foot. The patient’s heparin was partially reversed with 50 mg of protamine, given slowly IV.
All wounds were then copiously irrigated with normal saline and Kantrex. The leg and groin incisions were closed with #2-0 and #3-0 PDS. The skin was reapproximated with #3-0 nylon sutures in the groin and stainless steel clips at the knee. Needle and sponge counts were correct x2. The patient was then transported to recovery in a stable condition.
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