DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Nonhealing right TMA site.
POSTOPERATIVE DIAGNOSIS: Nonhealing right TMA site.
PROCEDURE PERFORMED: Aortogram with runoff.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: Local with sedation.
IV FLUIDS: 500 mL.
ESTIMATED BLOOD LOSS: Minimal.
URINE OUTPUT: Not recorded.
PROCEDURE FINDINGS: See below.
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old female with a prior history of an endo AAA repair. The patient has also had femoral endarterectomy on the right. She has an occluded SFA on the right and a nonhealing TMA site, which we are interrogating. The patient was consented and brought to the angio suite.
DESCRIPTION OF PROCEDURE: The patient’s left arm was prepped and draped in the standard surgical fashion. Percutaneous left brachial access was then obtained with a micropuncture kit. Next, the micropuncture kit 4-French catheter was then exchanged for a 5-French sheath. Bentson wire was then advanced into the brachial artery and to the thoracic artery. The descending aorta was then cannulated with a wire, and an Omni Flush catheter was then placed over the wire into the suprarenal aorta.
Next, the right limb of the graft was then cannulated, and an angled-tipped guidewire was then placed into the right limb of the graft. Hand injections were then performed. Just past the distal end of the right limb of the endograft was approximately 50% stenosis from the shelf of plaque. The external iliac artery was normal. The internal iliac artery was not visualized. The common femoral artery showed a patulous area with a prior patch angioplasty performed. The profunda appeared normally and was robust.
Continuing down the leg, the superficial femoral artery was thrombosed. At the knee joint, the popliteal artery does not reconstitute whatsoever. Below the knee of the trifurcation, does not reconstitute by collaterals. There did appear to be a reconstituted peroneal artery that was patent from the mid lower leg to the ankle. It bifurcated normally just above the ankle. This appeared to be a good runoff vessel diameter wise and seemed fairly free of disease. There did not appear to be anterior tibial or posterior tibial artery runoff to the foot. The patient tolerated the procedure well and will be scheduled for a femoral bypass if her symptoms continue to deteriorate.
