[Verified Answer]: 82-year-old patient rig82-year-old patient…

82-year-old patient rig82-year-old patient right-handed referred to vascular surgery clinic for right carotid artery stenosis. One-month prior patient presented to the emergency room with right hemispheric TIA (left arm paralysis). The patient had associated weakness, fatigue, and blurry vision which completely resolved prior to discharge during that admission. Patient was seen in the ER and started on aspirin 81mg. Outpatient clinic started on a statin but did not tolerate the medication (muscle cramps). Carotid Duplex showed 50-69% stenosis and CT angiography showed 70% stenosis. Consent was obtained for right carotid endarterectomy. Description: The patient was taken to the operating room and placed in supine position. General anesthesia was administered and the patient was intubated by the anesthesiologist. A right radial arterial catheter was then placed. A urinary catheter was also placed. The patient’s right neck was prepped and draped in usual sterile fashion. A safety pause was performed reviewing the patient’s identification, intended procedure, review of preprocedure labs and imaging, as well as necessary equipment in the room. The patient received Ancef antibiotics. After the safety pause was done, the rest of the procedure was allowed to continue. An incision was made on the anterior border of the right sternocleidomastoid muscle. This incision was taken down to the level of the right common carotid artery. Interestingly, the right internal jugular vein and the right facial vein were never encountered. The right common carotid artery was dissected free circumferentially and controlled with a vessel loop. The right vagus nerve was identified and kept from harm. Dissection was then continued cranially towards the right external carotid artery, which was then dissected free circumferentially and controlled with a vessel loop, The right superior thyroid artery was dissected free and controlled with a 2-0 silk tie. The right external carotid artery laid on top of the right internal carotid artery. Neurolysis of the right hypoglossal nerve allowed the right external carotid artery to be retracted medially. The right internal carotid artery was dissected free circumferentially and controlled with a vessel loop. The patient was then systemically heparinized with 6000 units of heparin. After 3 minutes, the previously placed vessel loops were secured in the order of the internal carotid, external carotid, and then the common carotid artery. An Il-blade scalpel was used to create an arteriotomy on the right common carotid artery, which was then extended using angled Potts scissors. A carotid shunt was prepared and placed first into the internal carotid artery and then into the common carotid artery. Flow through the shunt was confirmed with the Doppler probe. The endarterectomy was then performed in the usual fashion. The arteriotomy had to be extended both proximally and distally in order to achieve a good endpoint. The common carotid artery had a small shelf of plaque that was not tacked down. The Internal carotid artery required two 7-0 Prolene sutures to tack down the plaque. The bovine pericardial patch was then prepared. The arteriotomy was then closed using the bovine patch and 6-0 Prolenc suture in a running fashion. Prior to finishing the suture line, the carotid shunt was removed. The vessels were allowed to backbleed in the order of the external carotid, common carotid, and then the internal carotid artery. The suture line was then completed. Intraoperative duplex ultrasonography was then performed of the right carotid artery. The right common carotid artery had a peak systolic velocity of 66 cm/s, end diastolic velocity of 2 cm/s. The right external carotid artery had a peak systolic velocity of 186 cm/s, peak systolic velocity of 24 cm/s. The right internal carotid artery had a peak systolic velocity of 100 cm/s, end diaStolic velocity of 28 cm/s. There appeared to be no filling defects or flow-limiting lesions. The decision was made to not reverse the patient’s systemic heparin. There appeared to be good hemostasis. FloSeal 5 ml was applied to the surrounding tissues. The sternocleidomastoid muscle was reapproximated using interrupted 3-0 Vicryl sutures. The platysma was reapproximated using 3-0 Vicryl suture in a running fashion. The deep dermal layer was reapproximated using 3-0 Vicryl suture in a running fashion. The skin was closed with 4-0 Monocryl in a running subcuticular fashion. The wound was then dressed with Steri-Strips, 4 x 4 gauze, and Tegaderm tape. Manual pressure was held on the neck as the patient awoke from anesthesia. Patient was extubated successfully and was moving all 4 extremities and following commands. Patient was then transferred to the recovery room in stable condition. ICD-10-CM code(s): ICD-10-PCS code(s):