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)