DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left femorotibial vein bypass stenosis.
POSTOPERATIVE DIAGNOSIS: Left femorotibial vein bypass stenosis.
OPERATION PERFORMED: Revision of left femorotibial bypass with patch angioplasty.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General, orotracheal intubation.
DRAINS: None.
SPECIMENS: None.
DESCRIPTION OF OPERATION: The patient was placed supine. The abdomen, both groins, and left lower extremity were prepped and draped in the usual aseptic fashion. A longitudinal incision was made in the left groin. The common femoral artery was identified at the level of the inguinal ligament. The dissection was continued distally. The patient was systemically heparinized. The profunda femoris was identified and dissected free from the surrounding tissue. The vein graft was identified and dissected free for 4 cm distal to the anastomosis. Following an adequate circulation time, the common femoral was clamped with an angled DeBakey clamp. The profunda was controlled with a straight bulldog.
A longitudinal arteriotomy was made in the hood of the graft and extended proximally and distally. Retrograde hemorrhage from the graft was controlled with a Pruitt balloon occlusion catheter. A tight web-like stenosis was noted in the proximal portion of the vein graft. The stenosis was related in the intimal hyperplasia. Traction sutures were placed medially and laterally. A Hemashield Finesse patch was selected and prepared. The distal aspect of the repair was started with a horizontal mattress stitch of 5-0 Prolene suture. The medial and lateral aspects of the repair were then completed using U-clips. The patch was then placed in the appropriate degree of tension and cut to length in a taper. The proximal aspect of the patch was attached using 5-0 Prolene suture in a horizontal mattress fashion. The remainder of the repair was completed with U-clips.
Prior to completion of the medial aspect of the repair, the area was flushed antegrade and retrograde. The balloon was removed and the repair was completed. Flow was initially reestablished into the profunda femoris. Following several cardiac cycles, flow was reestablished into the vein graft. Several repair stitches of 6-0 Prolene suture on a BV-1 needle were utilized. The area was irrigated and examined for hemostasis. Surgicel was placed over the patch. The wound was closed in layers using 2-0 and 3-0 Vicryl sutures. The skin was closed with 3-0 nylon vertical mattress stitches. A palpable graft pulse was evident at the knee. The patient tolerated the procedure well. There were no apparent complications.
