Procedure:  Endovascular repair of abdominal aortic aneurysm with bifurcated modular aortobi-iliac stent graft device via bilateral femoral arteriotomies under fluoroscopic guidance, +/- placement of bilateral iliac limb extenders.  [add additional procedures, e.g., stent/PTA/embo, if performed intraoperatively]

Impression:  Successful placement of Zenith bifurcated modular aorto-bi-iliac stent graft device +/- bilateral iliac limb extenders as treatment of abdominal aortic aneurysm, as described above.

The operation was performed by physician members of the Indiana Vascular Institute.

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After bilateral femoral exposure was obtained (described in a separate dictation by Dr. Lalka), the patient was anticoagulated with 100U/kg intravenous heparin.  When the ACT was adequately prolonged, 9F vascular sheaths were introduced into both common femoral arteries using a modified Seldinger technique following puncture of each vessel with a 19 gauge single wall needle.  A 5F flush catheter was advanced through the (CONTRA = Left/Right) sheath to the proximal abdominal aorta. 

A Berenstein catheter was used to advance a Bentson guidewire through the (IPSI = Left/Right) femoral sheath to the level of the proximal descending thoracic aorta.  The Bentson guidewire was replaced with a Lunderquist wire, and the Berenstein catheter was removed.  The deployment sheath containing the main body of the Zenith aortic stent graft was advanced over the Lunderquist wire such that its most proximal covered stent body was approximately at the level of the renal arteries.  Digital subtraction abdominal aortography was performed following contrast administration through the flush catheter, and the levels of the renal arteries were noted. 

The main body of the Zenith aortic stent graft was delivered as described by Dr. Lalka in a separate dictation.

A Berenstein catheter was advanced through the (CONTRA = Left/Right) femoral sheath and advanced over a Glidewire into the open (CONTRA = Left/Right) limb of the main body of the stent graft device to allow subsequent placement of the contralateral iliac limb.  After removal of the Glidewire, contrast injected through the catheter opacified the interior of the device, demonstrating successful cannulation. 

Deployment of the proximal uncovered suprarenal stent of the main body of the stent graft was performed as dictated by Dr. Lalka.  A Bentson guidewire was advanced through the Berenstein catheter which had been advanced through the contralateral limb to the proximal descending thoracic aorta.  The Bentson guidewire was replaced with a Lunderquist wire, and the Berenstein catheter removed.  Thus, Lunderquist wires extended from both femoral artery sheaths to the thoracic aorta. 

DSA images of the (CONTRA = Left/Right) common iliac artery were obtained following RETROGRADE contrast adminstration through the (CONTRA = Left/Right) femoral sheath.  Those images demonstrated the caliber and course of the (CONTRA = Left/Right) common iliac artery and the level of origin of the internal iliac artery on that side.  An appropriate length and caliber Zenith iliac limb stent graft was advanced over the (CONTRA = Left/Right) Lunderquist wire and positioned such that there was adequate overlap between the main body device and the iliac device, and such that the distal portion of the iliac device did not cross the internal iliac artery origin.

As dictated by Dr. Lalka, deployment of the main body of the device was completed.  Following that, DSA images of the (IPSI = Left/Right) common iliac artery were obtained and the (IPSI = Left/Right) Zenith iliac limb stent graft was delivered as described above for the (CONTRA = Left/Right) side.

Following “molding” of the entire stent graft with a low compliance balloon as described by Dr. Lalka, a 5F flush catheter was advanced over the (COULD BE EITHER = Left/Right) Lunderquist wire to the proximal abdominal aorta.  DSA images of the aorta, renal arteries, and proximal stent graft were obtained following contrast administration.  These images showed no evidence of endoleak and a widely patent stent graft.  The catheter was withdrawn to the level of the mid portion of the main body of the stent graft, contrast injected, and images of the distal graft and iliac arteries were obtained.  Again, these images showed no endoleak and excellent positioning of the widely patent stent graft.

All guidewires, catheters, and sheaths were removed and the femoral arteriotomies and wounds closed as will be described by Dr. Lalka in a separate dictation.

Dr(s) Lalka (and ____) of vascular surgery and (_____) of interventional radiology were present for the procedure.