[Solved]: Preoperative diagnosis: Large left internal iliac…

Preoperative diagnosis: Large left internal iliac artery aneurysm Postoperative diagnosis: Same Operation performed: Stent graft of left iliac artery (AneuRx 20 x 55 and 16 x 115) Anesthesia: General Complications: None Procedure: In the operating room, the patient was placed under anesthesia. Both the groin and the abdomen were prepped with DuraPrep and sterile drapes applied. The surgeon explored the left common femoral artery through a 2cm longitudinal incision just below the groin crease. Dissection was carried out with cautery. The femoral artery was large. This was dissected free and a vessel loop passed around. Proximally, the vessel was controlled just above the circumflex iliac vessel with umbilical tape. The femoral artery was accessed with a 19-gaugc needle and J-tipped guidewire. An 11 sheath was placed. Bentson wire was advanced up through the sheath and placed in the aorta. A marker catheter now advanced over thc wirc and positioned across the iliac artery. Hand injections were carried out showing that the left internal iliac artery was occluded. Patient was now heparinized with 40()0 units of heparin. An AneuRx 16 x 16 x 115 stent graft was now chosen. The sheath was then removed. This was placed up over the wire and positioned in the left internal iliac artery. There was a good overlap of the internal iliac artery orifice, although with deployment of this graft, it sccmed to slip so that we did not have good coverage in the common iliac artery. It was only about a 1.5 cm overlap. The stent was opened up with the Reliant balloon. Hand injection through the sheath, however, showed some endoleak and insufficient proximal covcragc. Therefore, a second stent graft was placed up over the wire. The second stent was an AneuRx 20 x 20 x .S.S placed up over the wire. There was about a 2 cm overlap with the existing stent graft, then carried up into the very proximal common iliac artery but staying below the aortic bifurcation. The aortic bifurcation was identified with a retrograde injection on the right sidc as well as placing an OmniFlush catheter up over the aortic bifurcation. The second stent graft was deployed proximally and in good positon. A Reliant balloon was used to opcn it up. Hand injection through the sheath distally showed good positioning of the graft and there was no cndolcak. Thcreforc, thc sheath and guidewire were removed, the femoral artery clamped proximally and distally, and the arteriotomy closed transversely with a running 5-() Prolene suture. The groin was closed in layers of 2-0 Vicryl. Skin closed with a running 4-0 Vicryl subcuticular suture and Angioscal placed on the right side. Patient tolerated the procedure well. ICD-10-CM code(s): ICD-10-PCS code(s):