Question

Operative Report Patient Name Robert Duckington Birth date 02 Patient Number: 22-12 Room Number: 131 DATE OF OPERATION: 09/12 PREOPERATIVE DIAGNOSIS B post pulmonary with cod eal deep v e Cod o bis, hypercoagulable state, status i ce POSTOPERATIVE DIAGNOSIS: Bilateral deep throsis, hypercoagulable state was post e mbols with condition to Coumadination OPERATIONE Insertion of inferior vena cava, infraral and suprarenal Greenfield filters even SURGEON: Nicholas Wallin, MD ANESTHESIA: Local with monitored nesthesia INDICATIONS. This 35-year-old wami wi e chydration with know factor V Leiden mutation with typercome a nd polycythmiast post pulmonary embolus in July 2002, admitted with bilateral DVT.se status post left hemispheric cerebral infarct with compliance. For that as a condition to Coumadin anticoagulation PROCEDURE: With the patientlyingine and undersdation, the neck slightly hyper- extended and the head turned to the left the neck, shower, and upper chest were prepped with Betadine, and senle drapes were applied. The skin were infiltrated with 1% lidocaine. Percutaneous puncture of the internal en was accomplished and for that reason, a small cut down along the space between the two mocleidomastoid muscles was made, bleeders being electrocauterized. The internal l ar en exposed found to be quite far. A stay wuture of 5.0 cardiovascular Prolene was applied, and in the Seldinger technique, the guide wire was advanced under C-arm fluoroscopy down to the level of 3 4. The introduction mechanism with dilator was the advanced wong the wide wire, the dilator being removed, leaving the sleeve behind The inferior co m was performed using nonconic contrast material, which showed a part inferiores cavas well as the real veins without detects the love was again gated with her a nd the filter a vanced under arm y and deployed at the level of that the filter failed to open. For that a different fier deployed as position. This time, the filter opened well The introduction mechanism was removed the defect in the internal juvenated with a new of Scandic Prolene Hemostasis appeared the skin and h a s layers on the the whole tissue with interrupted of Death with San S e dressing Wed The patientered the procedure well. The Woodwa invece code l e wataken to the What was the preoperative diagnosis? Please define each term. What type of surgery was performed? Please define each term. Under Indications: define polycythemia and DVT. What type of radiograph (x-ray) was performed with nonionic contrast material? How was the defect in the internal jugular vein controlled during surgery? 5.

Answer 1

1. preoperative diagnosis is,

BILATERAL DEEP VEIN THROMBOSIS: The most common type of venous thromboembolism is DEEP VEIN THROMBOSIS, which occurs in veins deep within the muscles of the leg, arm and pelvis, here it’s both sides of the body. hence this is the formation of blood clot in both deep veins of the body.

Deep Vein Thrombosis (DTV) Embolus Deep Veins of the Leg Normal Blood Flow Deep Vein Thrombosis

HYPERCOAGULABLE STATE: hyper coagulable state is the condition of abnormally increased tendency towards clotting of blood which means patient is now very prone for coagulation of blood. (COAGULATION: CLOTTING OF BLOOD)

PULMONARY EMBOLISM

A pulmonary embolism occurs when a blood vessel in your lung becomes blocked by a blood clot (thrombus) that travels to your lungs from another part of your body, usually your leg. Patient is already a case of pulmonary embolism.

trachea right lung pulmonary embolism branch of pulmonary artery alveolus branch of pulmonary artery

COUMADIN, Jantoven is a one of the treatment or medication to prevent coagulation of blood, it acts as thinners for blood by breaking the blood clots. Here patient has the contraindication for the coumadin drug because of the the status post left hemispheric cerebral infarct

2.PROCEDURES DONE ARE,

IT IS A CLOSED MINOR TYPE OF SURGERY DONE WITH EXTERNAL INCISSIONS.

Here they’ve done the insertion of supra (above the kidney level) renal venacava and infra renal (below the kidney level) venacava greenfield IVC filters along with the help of inferior venacavogram

INSERTION OF INFERIOR VENACAVA:

The IVC filter is placed by incision in vein in your groin or neck. A thin, flexible tube (catheter) is inserted into this vein. The catheter is then gently moved into your IVC. A collapsed IVC filter is sent with the catheter. The filter is left in place, and the catheter is removed. The filter then expands and attaches itself to the walls of the IVC. It may be left in place permanently. In some cases, it may be removed after a period of time.

25 mm

INFRARENAL AND SUPRA RENAL GREENFIELD FILTERS

v An IVC filter is one method to help prevent pulmonary embolism. Your inferior vena cava (IVC) is the major vein that brings oxygen poor blood from the lower body back to the heart.

v The heart then pumps the blood to the lungs to pick up oxygen.

v An IVC filter is a small, wiry device.

v When the filter is placed in your IVC, the blood flows past the filter.

v The filter catches blood clots and stops them from moving up to the heart and lungs

v This helps to prevent a pulmonary embolism.

INFERIOR VENACAVO GRAM

It is a thin flexible tube used to help in surgery, it helps to provide x-ray pictures of the venacava by inserting inferiorly.

1. POLYCYTHEMIA: is the elevation of the volume percentage of red blood cells.

DEEP VEIN THROMBOSIS is the formation of a blood clot in one of the deep veins of the body, usually in the leg

1. THEY USED THE METHOD OF INFERIOR VENACAVO GRAM

It is a thin flexible tube used to help in surgery, it helps to provide x-ray pictures of the venacava by inserting inferiorly.

1. THE INTERNAL JUGULAR VEIN WAS EXPOSED AND FLAT, SO HERE THEY, VE MADE A STAY SUTURE OF 5-0 CARDIOVASCULAR PROLENE IS APPLIED AND A GUIDE WIRE IS ADWANCED UNDER C-ARM FLUROSCOPY DOWN TO THE LEVEL OF L3-L4, WITH THE SELDINGER TECHNIQUE

SELDINGER TECHNIQUE: A technique used to obtain safe access to blood vessels veins and other hollow organs.