DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Chronic renal failure, multiple pseudoaneurysms, right upper arm graft.
POSTOPERATIVE DIAGNOSIS:
Chronic renal failure, multiple pseudoaneurysms, right upper arm graft.
PROCEDURES PERFORMED:
Excision of pseudoaneurysms, insertion of graft.
SURGEON: John Doe, MD
ANESTHESIA: General.
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old female with chronic renal failure who presented with dysfunction of right upper arm graft manifested by a large lemon-sized aneurysm in the upper arm graft. This was partially excised and bypassed with insertion of new piece of graft. This was an Intering 6 mm Gore-Tex graft.
DESCRIPTION OF PROCEDURE: The patient’s arm was prepped and draped in the usual manner. Under general anesthesia, an incision was made distal and proximal to the pseudoaneurysm which occupied two-thirds of the upper arm graft. The aneurysm extended from the brachial artery up to high in the graft. Incision was carried through the skin and subcutaneous tissue down proximal to the aneurysm and the brachial artery anastomosis down to the graft. The graft was encircled with vessel loops. By means of blunt and sharp dissection, the graft was clamped, partially transected. Heparinized saline was introduced in both ends. The venous end was isolated by making an incision through skin and subcutaneous tissue down to the graft. It was isolated with blunt and sharp dissection. The graft was partially transected. Heparinized saline was introduced in the venous end and both sides of the aneurysm were partially excised with sharp dissection using the Bovie knife. The bed of the graft was cauterized with a Bovie knife.
A new piece of Gore-Tex graft 6 mm Intering graft was anastomosed in an end-to-end fashion to the arterial side of the graft with two continuous 5-0 Polysorb sutures. Heparinized saline was introduced in the end and the graft was tunneled by making a contralateral incision around the old pseudoaneurysms site in subcutaneous tissue with a tunneling instrument. Two incisions were made and the graft was brought up to the venous end. An end-to-end anastomosis was fashioned with a single 5-0 Prolene suture. Upon releasing the clamps, a good thrill was obtained. Bleeders were electrocoagulated. A bleeder at the suture line, which was severe, was controlled with thrombin and Gelfoam. The incision was closed in layers with vertical mattress using 4-0 nylon and the working incision, the arterial side, with two layers of 4-0 Monocryl and PDS for the subcutaneous tissue, Monocryl for the subcutaneous tissue. Steri-Strips were applied. The patient left the OR in stable condition.
