DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Arterial insufficiency of lower extremities.
2. Previous right femoropopliteal artery bypass.
3. Diabetes mellitus.
POSTOPERATIVE DIAGNOSES:
1. Arterial insufficiency of lower extremities.
2. Previous right femoropopliteal artery bypass.
3. Diabetes mellitus.
OPERATION PERFORMED: Aortogram with long leg runoff.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: Local MAC.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old Caucasian male patient who was seen in the office and evaluated for arterial insufficiency of the lower extremities. The patient states that he could only walk 50 to 60 feet before having severe pain. The patient underwent arterial Doppler, which showed some diminish with exercise. He was recommended to undergo an aortogram with runoff. The patient was explained the procedure, risks, and possible complications. He was admitted and found to have hypokalemia and hyperglycemia. His procedure was canceled. The patient was evaluated and optimized and now presents today. The patient has been explained the procedure, risks, and possible complications.
DESCRIPTION OF PROCEDURE: The patient was brought to the operative room and was sterilely prepped and draped in the supine position. The left common femoral artery was cannulated. There was noted to be a great deal of scar tissue in the inguinal region. A 0.35 wire was passed and a 5-French Cordis introducer was attempted to be inserted.
Because of the scar tissue, however, this was unable to be negotiated, and a 7-French Cordis introducer was inserted and sutured into place with a 2-0 silk tie. A 0.35 wire was placed in the suprarenal aorta and a 5-French pigtail catheter inserted. An aortogram was obtained. This showed single renal artery without significant stenosis, a diffusely diseased abdominal aorta, common iliac, and external iliac arteries, but no significant stenoses. The left superficial femoral artery was noted to be patent, but diseased. There was a great deal of disease in the tibial vessels below the knee. Long leg runoff on the right revealed occlusion of the right femoropopliteal artery bypass with right superficial femoral occlusion and reconstitution in the popliteal artery below the knee. There was 2-vessel runoff consisting of the peroneal artery and anterior tibial arteries.
A total of 225 mL of contrast was used. The guidewire was then straightened and used to straighten the pigtail catheter. The Cordis introducer was removed and hemostasis was obtained with 15 minutes of pressure followed by Syvek patch. The patient was then transported to the recovery room in stable condition.
