ANESTHESIA: Spinal. 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 8 French sheath was placed into the right common femoral artery.
Subsequently, a 19 gauge introducer needle was inserted into the left common femoral artery, without difficulty and 8 French sheath was inserted.
A pigtail catheter was inserted into the aorta and an angiogram was performed obtaining size measurements.
For the main a 31 mm x 14.5 mm x 17 cm Gore Excluder Trunk-Ipsilateral Leg (main body) stent was used with right side as the ipsilateral side. This was inserted via a 18 French sheath over an Amplatz super-stiff wire. The top of the stent was placed just inferior to the left renal which was the lowest renal artery. The main body stent was successfully deployed with contralateral gate open, using a “ballerina” configuration. The contralateral gate was accessed using a glide wire and and confirmed using the angiogram as well as a twirled pigtail catheter. Additional angiograms were obtained to localize the hypogastric arteries.
Subsequently a 14.5 mm x 10 cm Gore Excluder Contralateral Leg stent was inserted into the left groin, using a 12 French sheath and over an Amplatz super-stiff wire.
After this a Coda balloon was used to appose the graft against the aorta and against the left common iliac artery. In addition, 14 mm x 4 cm balloon was used to appose the graft at the connection site and again the right common iliac artery.
Final angiogram was performed using a pigtail catheter. No endoleak was identified.
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 6000 units of IV heparin with boluses during the course of the procedure.
IMPRESSION:
Successful infrarenal abdominal aortic aneurysm repair using 31 mm x 14.5 mm x 17 cm Gore Excluder Trunk-Ipsilateral Leg (right main body) stent and 14.5 mm x 10 cm Gore Excluder Contralateral Leg stent (left)
Frequently Asked Questions
What is a Gore AAA stent graft repair?
A Gore AAA stent graft repair is a minimally invasive procedure used to treat an abdominal aortic aneurysm (AAA). The technique involves placing a stent graft inside the aorta to reinforce the weakened artery wall and prevent rupture. The Gore Excluder device is commonly used for this procedure, offering a less invasive alternative to open surgery, which typically has a quicker recovery time.
How is anesthesia managed during a Gore AAA stent graft repair?
During a Gore AAA stent graft repair, spinal anesthesia is commonly used. This type of anesthesia numbs the lower part of the body, allowing the patient to remain awake but pain-free during the procedure. The anesthesia team monitors the patient closely, ensuring comfort and safety throughout the surgery.
What are the steps involved in the Gore AAA stent graft procedure?
The procedure involves several key steps: preparing the abdomen and groin areas, making incisions to access the femoral arteries, inserting a sheath, and using imaging to guide the placement of the stent. The main stent is deployed in the aorta, followed by the contralateral leg stent, which is adjusted using balloon catheters to ensure proper fit and function, preventing any leaks.
What are the benefits of using a stent graft for AAA repair?
Stent grafts offer several benefits for AAA repair, including reduced recovery time and lower risk of complications compared to open surgery. The minimally invasive nature of the procedure means less pain and scarring, and patients can often return to normal activities more quickly. Additionally, the stent graft provides a durable solution to prevent aneurysm rupture.
What are the potential complications of a Gore AAA stent graft repair?
While generally safe, the Gore AAA stent graft repair can have potential complications, such as endoleaks, where blood leaks into the aneurysm sac. Other risks include infection, damage to surrounding blood vessels, and kidney problems due to contrast dye used during imaging. However, these complications are relatively rare and often manageable with appropriate care.
How long does recovery take after a Gore AAA stent graft repair?
Recovery from a Gore AAA stent graft repair is typically faster than from open surgery. Most patients spend a few days in the hospital and can return to normal activities within a week or two. Full recovery may take a few weeks, during which patients should avoid heavy lifting and follow their doctor's advice on activity levels and wound care.
What is the role of angiograms in the Gore AAA stent graft procedure?
Angiograms are crucial in the Gore AAA stent graft procedure as they provide live imaging of the blood vessels. This helps the surgical team accurately measure the aorta and guide the placement of the stent graft. Angiograms ensure that the stent is positioned correctly and confirm the patency of the arteries after the procedure.