I GOT 34705 & 34812/50. IT DOESN’T SEEM RIGHT… THANKS!! CAROL
PRE-OPERATIVE Abdominal aortic aneurysm.
DIAGNOSIS: POST-OPERATIVE Same.
DIAGNOSIS: ESTIMATED BLOOD Less than 20 cc. LOSS
ANESTHESIA: General anesthesia.
DESCRIPTION OF PROCEDURE: Right and left common femoral arteries were accessed percutaneously and a Perclose sutures were placed bilaterally using the pre-close technique. Catheter and guidewire
techniques: were used to manipulate a Lunderquist wire from the left common femoral
arteriotomy to the mid thoracic aorta. Catheter and guidewire techniques were used to
manipulate a pigtail catheter to the upper abdominal aorta. Over the left-sided
Lunderquist wire, the main body Endurant stent graft measuring 16 x 13 x 124 mm mm
was advanced to the upper abdominal aorta. An aortogram was performed in the
craniocaudal projection to delineate the takeoff of the renal arteries. The stent graft was
then deployed to the level of the gate such that the proximal fabric lies immediately
distal to the takeoff of the lower most left renal artery. The hooks were deployed in
usual fashion. Next, the right-sided pigtail catheter was straightened and used to select
the gate. The pigtail catheter was advanced into the main body stent graft and spine to
ensure its intraluminal position. A Lunderquist wire was then advanced into the pigtail
catheter A right-sided iliac angiogram was performed to delineate the position of the
native aortic bifurcation and right hypogastric artery. The pigtail catheter was
exchanged over the Lunderquist wire for the delivery system for a right-sided iliac
extender measuring 25 x 13 x 166 mm. This was advanced into the gate and deployed
in the usual fashion such that the distal fabric is immediately proximal to the right
hypogastric artery takeoff. The delivery system was then removed and replaced with a
12 French sheath Next, the main body stent graft was deployed in its entirety. The
delivery system was then removed and replaced with a 14 French sheath. Next, the stent
graft and both right and left limbs were dilated using Reliant balloons and kissing
balloon technique. Next, both right and left arteriotomies were closed using the Perclose
sutures and satisfactory hemostasis was obtained.
ANGIOGRAPHIC FINDINGS: Following placement of a modular bifurcated stent graft, there is satisfactory flow through the stent graft and both right and left limbs. There is maintenance of patency of
both right and left renal arteries and right and left hypogastric arteries. There is a slight
proximal type I endoleak present which was refractory to multiple balloon dilatations at
the proximal landing zone.
COMPLICATIONS: None.
CONCLUSION: Successful placement of a modular bifurcated stent graft for treatment of an infrarenal
abdominal aortic aneurysm. At the conclusion of the procedure, the stent graft is in
satisfactory position with excellent flow. A slow filling proximal type I endoleak
persists despite multiple balloon dilatations at the proximal landing zone. The patient
will be followed with CT scanning in approximately one week. Should the patient have
a persisting type I endoleak, the plan is to the percutaneously additional stents at the
level of the proximal landing zone.