DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right brachial sheath, status post aborted endovascular repair of right subclavian pseudoaneurysm.
POSTOPERATIVE DIAGNOSIS: Right brachial sheath, status post aborted endovascular repair of right subclavian pseudoaneurysm.
PROCEDURES PERFORMED:
1. Removal of right brachial sheath.
2. Primary repair of right brachial artery.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General via a laryngeal mask airway.
INDICATION FOR PROCEDURE: This is a patient with a right subclavian artery pseudoaneurysm, status post stab wound. The patient underwent diagnostic angiogram for evaluation for possible endovascular repair. Initially, it appeared feasible; however, after the sheath was upsized to a 9 French sheath and repeat angiogram was performed, the lesion did not appear well suited for an endovascular repair. Preoperatively, the patient was informed and counseled about the need for operative removal of sheath if a large sheath was utilized.
DESCRIPTION OF PROCEDURE: The patient was placed supine with the right upper extremity abducted to 90 degrees. The area was prepped and draped in the usual aseptic fashion. A longitudinal incision was made along the medial border of the distal right arm proximal and distal to the sheath entry side. Subcutaneous tissues were divided using electrosurgical dissection. Fixed retractors were placed. The dissection was continued deep to the brachial artery. The artery was encircled with a vessel loop proximally and distally. Manual pressure was placed on the proximal artery as the sheath was removed.
A brachial artery clamp was then placed. Brisk retrograde hemorrhage was noted. A brachial artery clamp was placed distally. The defect was closed using a 6-0 Prolene suture on a BV needle. Interrupted stitches were placed. Prior to completion of the repair, the area was flushed antegrade and retrograde. The repair was completed and flow was reestablished to the right forearm. A palpable radial pulse was evident.
The wound was irrigated and examined for hemostasis. The wound was closed in layers using 2-0 and 3-0 Vicryl sutures. The skin was closed with a 4-0 Monocryl subcuticular stitch. The patient tolerated the procedure well. There were no apparent complications. The patient was transported to the postanesthesia care unit without incident.
