Part 1: Spend 30 days in the shoes of someone

Case 2: Operative Report PREOPERATIVE DIAGNOSIS: High-grade left internal carotid artery stenosis POSTOPERATIVE DIAGNOSIS: High- grade left internal carotid artery stenosis PROCEDURES: Left carotid endarterectomy and bovine patch angioplasty and Shunt INDICATIONS: A 61-year- old woman with high-grade stenosis detected on duplex imaging. The technique, risks, and benefits of the procedure were discussed at length with the patient and agreed to proceed. FINDINGS: High-grade mixed plaque involving the carotid bulb and proximal internal carotid artery. A shunt was used throughout the reconstruction. A bovine patch was used to reconstruct the artery. 6 2: ICD-10- PCS Coding Guidelines OPERATIVE REPORT: After informed consent was obtained, the patient was met in the procedure room. Her left neck was prepped and draped in normal sterile surgical fashion. A curvilinear neck incision was made along the anterior border of the sternocleidomastoid muscle. This was deepened down to the platysma muscle. The carotid sheath was opened and the carotid artery was circumferentially dissected and controlled. We identified the vagus and hypoglossal nerves, both of which were protected throughout the dissection. We heparinized the patient with 100 units/kg of Heparin IV. After adequate circulation time, we placed our clamps distal and then proximal. A longitudinal arteriotomy was created and a shunt was inserted. Antegrade flow was then restored through the shunt. The endarterectomy was performed in the usual fashion. We were able to obtain a nice tapered end point. Once we removed all loose intimal debris, we applied a bovine pericardial patch. A running 6-0 Prolene was used. Prior to completing anastomosis, we removed the shunt. The vessel was flushed antegrade and retrograde. Repair sutures were placed as necessary. Antegrade flow was then restored first to the external and to the internal. We checked signals distally. Once we were happy with flow, we irrigated the wound copiously. Protamine 30 mg was given to partially reverse the heparinization. Gelfoam and thrombin were also used to aid with hemostasis. We irrigated the wound once again and closed in layers using Vicryl and Monocryl. All counts were correct ×2 at the end of the procedure. Sterile dressings were applied and the patient transported to recovery room in satisfactory condition.

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