Replacement of ascending aorta with 2. Hemashield graft. PREOPERATIVE DIAGNOSIS.
Irregular Neointimal Lining with Prominent Proliferative Activity After Carotid Patch Angioplasty: An Autopsy Case Report. Covered Stents for Treating Aortoiliac Occlusive Disease. Despite the excellent results achieved with percutaneous transluminal angioplasty and stenting. Covered Stents for Treating Aortoiliac Occlusive Disease. Systematic Review of Randomized Controlled Trials of Different Types of Patch Materials during Carotid Endarterectomy Shiyan Ren mail. Pseudoaneurysm Formation following Carotid Endarterectomy: Two Case Reports.
Acute type A aortic dissection with arch dissection. POSTOPERATIVE DIAGNOSIS: Chronic type A aortic dissection with acute tear at the mid arch withrupture. OPERATION: 1. Replacement of ascending aorta with 2. Hemashield graft. Reimplant of innominate and left carotid artery with a 1.
- Replacement of ascending aorta with 22 mm Hemashield graft PREOPERATIVE DIAGNOSIS. At this time, once the reinforcement was.
- Endarterectomies were extended proximally and distally beyond grossly diseased intima. Several studies have reported that CEA with patch angioplasty has superior. CEA with a Hemashield patch has a higher.
- Purpose: Several studies have reported that carotid endarterectomy (CEA) with patch angioplasty has results that are superior to primary closure.
- Patch Angioplasty Karim Brohi, trauma.
- Op Report Coding Blog. Code sample Op Reports and compare your answers to other coders. Post details: Carotid endarterectomy with Angioplasty 02/22/07. 04:51:12 am, by ritecode, 1066 words, 93228 views.
Hemashield graft and a right axillary arterycannulation and repair with retrograde cerebral perfusion andselective antegrade cerebral perfusion via the Hemashield graftwith hypothermic circulatory arrest. Repair of left femoral artery. Repair of right axillary artery.
Was replaced by a 26 mm Hemashield Platinum (Maquet Car-diovascular, Fairfield, NJ. Despite the strong resistance of the aortic intima to in-.
SURGEON: A, M. D. ASSISTANTS: ANESTHESIA: General endotracheal tube anesthesia. ESTIMATED BLOOD LOSS: SPECIMENS REMOVED: INDICATIONS: DESCRIPTION OF PROCEDURE/FINDINGS: Briefly, patient was identified in the holding area after beingtransported by helicopter from the Lower Keys Medical Center with anacute type A dissection. CAT scan was reviewed and the patient wasurgently taken to the operating room.
Once placed to the operatingroom, the patient was given general endotracheal tube anesthesia andpreoperative antibiotics. All appropriate monitors were placed whichincluded a right and left radial A- lines, with a right internaljugular Swan- Ganz catheter, and Foley catheters were placed. Allappropriate monitors were placed and a transesophageal echo wasperformed.
Once the patient was prepped and draped, a transesophageal echoverifies an arch dissection with a tear just proximal to the leftsubclavian artery, with true and false luminal flow in basal arteryon the transesophageal echocardiogram. The patient had no aorticinsufficiency and dissection starting at the sinotubular junction.
Soat this point, since the patient had an arch dissection with thepossibility of selective antegrade cerebral perfusion, we decided toperform a right axillary artery cannulation. So, at this point, an incision was made in the right subclavicularregion. We were able to cut down the subcutaneous tissue with the. Bovie cautery, achieving hemostasis. At this point, the pulsatilesubclavian artery was identified and we were able to isolate it moreproximally and distally with vessel loops. At this point, a modified.
Seldinger technique was utilized with the guidewire without anyresistance; and with a subcutaneous tissue dilator over theguidewire, we were able to place in an 1. French arterial cannulainto the subclavian artery without any difficulty and without anyresistance. This was connected to arterial line and cardiopulmonarybypass circuit. This was done with 1. At this point, sternotomy was created from the jugular notch to thexiphoid process, and entering through the subcutaneous tissue withthe Bovie cautery, and the midline of the sternum was transected witha sternal saw.
Once the sternum was transected, the sternum was madehemostatic with Bovie cautery in both the anterior and posterioraspect of the sternum, and a sternal retractor was inserted. At thispoint, the pericardium was opened in a reverse- T fashion and tackedup to the sternal wall in four different quadrants.
A dilatedascending and arch of the aorta were identified with evidence ofacute dissection and ecchymosis of the arch. At this point, thepursestring suture was placed in the right atrial appendage, and adual- stage venous cannula was inserted into the IVC from the rightatrial pursestring suture, and a retrograde cardioplegia line wasinserted into the coronary sinus via pursestring suture in the bodyof the right atrium.
At this point, the patient was commenced oncardiopulmonary bypass. Once commenced on cardiopulmonary bypass, thepatient was allowed to cool and we able to cool the patient down to.
Celsius, which took about 4. As the patient wasbeing cooled, we were able to mobilize the aorta and the innominatevein, identifying the arch vessels. Once the arch vessels wereidentified coming off the aneurysm, we were able to isolate theinnominate and the left carotid artery, which were very close to eachother, which was almost like a bovine arch; and we were able toisolate the left subclavian which was very distal right after theevidence of the ecchymosis and tear. So, we believe that this was atype B dissection with retrograde dissection toward the ascendingaorta. As the patient was being cooled, we identified that theaxillary flow was not great and we felt that maybe the dissection wasinvolved in the flow resistance from the cardiopulmonary bypasscircuit, as the patient being cooled.
So, then we stopped the flowfrom the right axillary and cannulated the left femoral artery. Thiswas done in the routine fashion, isolating the femoral artery througha groin incision.
We were able to cannulate this with an 1. Frencharterial cannula, and then the flows were identified to be excellent,and we were definitely in the true lumen and there was good flow. Wewere able to arrest the heart with cold perfusion of thecardiopulmonary bypass circuit. As the heart block began tofibrillate, a Sarns vent was inserted into the right ventricle viathe right superior pulmonary vein, and we will continue to coolfurther for the duration of 4. We were able to remove thearterial line from the femoral cannula and place it in the SVCcannula for retrograde cerebral perfusion. At this point, we wereable to transect the ascending aorta just above the sinotubularjunction. I mobilized the entire ascending aorta all the way up tothe arch.
Once we obtained access to the arch, we were able toidentify an acute dissection at the arch, and a tear just proximal tothe left subclavian artery. At this point, the entire arch was ableto be transected; and once we were able to transect the entire arch,we were able to isolate the left common and the innominate artery.
The subclavian artery on the left was very close to the endpointwhere we were to reach our distal anastomosis, so we decided tomaintain continuity of the left subclavian artery to the distal aortaas one anastomosis so as not to anastomose separately. At this point,with the entire arch resected, we decided to perform a bifurcatingbranch graft with one branch encompassing the innominate and the leftcommon carotid together, reinforced with felt, such as almost like abovine arch, and we were able to utilize a 1. Oneof the 1. 0 mm side ports was transected and clamped, and the otherside port was utilized later for cannulation for antegrade selectivecerebral perfusion. At this point, the anastomosis was created with.
Prolene suture. Once the anastomosis was completed, the distalend of the graft was cannulated with an 1. French arterial cannula,and we were able to wire off the arterial line of the cardiopulmonarybypass circuit, and we are able to perfuse selectively both theinnominate on the right and the left common carotid a 1 L/minute andremain cool. Once this was performed, the retrograde cerebralperfusion was closed down, and we were able to connect our arterialline to the cannula of the Hemashield graft which was anastomosed tothe innominate and left carotid.
At this point, with the patient being selectively perfused, and thedistal anastomosis of the subclavian and the proximal distaldescending aorta were anastomosis, we were able to use felt with 4. Prolene suture in a circumferential fashion to reinforce the intimato the adventitia. Once this was able to be performed, we were ableto utilize a 2. Hemashield graft in a two- layer anastomosis using. Prolene suture once the anastomosis was completed. At this point,the Y of the arterial line was then connected to the femoralcannulation once again, and we were able to retrograde perfuse theremainder of the body, as we were still perfusing the brainselectively via the graft. At this point, we remained cool because wewere going to go on circ arrest for a second short period.
Once theperfusion had began to the lower extremity and to the remainder ofthe body, we were able to fill the graft; and once the distal aorticgraft was de- aired, a cross- clamp was placed on the graft and thepatient was now being perfused at 2 L/minute both in antegradeselective cerebral perfusion graft and via retrograde via the femoralartery. At this point, with the patient remaining cool and notperfusing, the distal anastomosis was performed from the subclavianand the distal arch using a 2. Hemashield graft. We then turned our attention to the root of the aorta. The coronary ostia were intact.
Cardioplegia was given bothin the coronary sinus and down the coronary ostium every 2. The Sarns vent was activated and theheart was completely decompressed, and the aortic valve was intact. The sinotubular junction was transected and the old calcified type Adissection was identified. We were to remove this part of thepathology of the aorta, sent off to the lab. At this point, using(.
At this time, once the reinforcement wasperformed, we were able to place our 2. Hemashield graft and thenanastomose this to the sinotubular junction using 4- 0 Prolene suturein a two- layer closure. Once this anastomosis was completed, we wereable to continue perfusion of the remainder of the body. However, atthis point, the graft was measured at the bifurcating graft, wherethe cannula was selectively antegrade perfusing the brain via theinnominate and left carotid. It was measured and, at this point,another period of circ arrest was performed. Once the cardioplegiacircuit was shut down, the cannula in the bifurcating graft to theinnominate was removed, and the graft was then measured to meet theascending aortic graft coming off the root, and this anastomosis wasthen created after (. Using a 5- 0 Prolene suture in a running fashion, the 1.
Once theanastomosis was completed, the de- airing needle was inserted into theascending aorta. Once the de- airing needle was placed into theascending aorta, the arterial circuit was connected back to thefemoral cannulation, and the patient was able to be de- aired. Oncethe graft was de- aired, a clamp was placed on the 1.