ANESTHESIA: See anesthesiology report for details.

PROCEDURE:

The abdomen and bilateral groins were prepped and draped in standard surgical fashion after anesthesia, provided by anesthesiology service.

Bilateral groin incisions were made in the oblique fashion and cut down exposing the bilateral common femoral arteries just below the inguinal ligament, by the vascular surgery team.

A 19 gauge introducer needle was inserted through tiny incisions inferior to the oblique incisions a 18 French sheath was placed into the right superficial femoral artery.

Subsequently, a 19 gauge introducer needle was inserted into the left common femoral artery, without difficulty and 6 French sheath was inserted.  Subsequently access was obtained into the left brachial artery and a 7 French sheath was placed over the wire.

A pigtail catheter was inserted into the aorta and an angiogram was performed obtaining size measurements. Access was subsequently obtained into the left renal artery via the left brachial artery access. Over the wire a 7 mm x 15 mm covered via bond stent was placed into the left renal artery. A 36 mm 4. Aortic cuff was placed to the level of the renal arteries. A second aortic cuff was placed.

A Coda balloon was used to appose the graft against the aorta and a 7 mm balloon used to appose the stent against the left renal artery together in a kissing fashion.

Final angiogram was performed using a pigtail catheter. demonstrates patency of the SMA and renal arteries bilaterally.

Bilateral renal arteries, hypogastric arteries and external iliac arteries were patent.

Subsequently, all wires, catheters and bilateral sheaths were removed.
The bilateral groin cut down was closed by the vascular surgery team.

Patient tolerated the procedure well without apparent immediate complications.

Patient was given 5000 units of IV heparin with boluses during the course of the procedure.

IMPRESSION:

Successful revision of abdominal aortic aneurysm stent using an aortic cuff and left renal artery stent (Snorkel technique)