Vascular

Question 1

EVAR STEPS:

Answer 1

1. Map aorta 3d reconstruction and size graft
2. Expose bilateral common femoral arteries
3. Introduce sheaths and catheters, perform aortogram
4. administer heparin
5. Place main body of endograft below renals
6. place contralateral iliac liimb
7. balloon angioplasty sealing zones / joints
8. completion angiogram

Question 2

Open AAA Repair Steps

Answer 2

1. Midline laparotomy, reflect small bowel to right, transverse colon cephalad
2. Dissect duodenum off aorta, exposing renal arteries. ligate left renal vein if necessary
3. Dissect distal aorta/proximal iliacs preserving sympathetics
4. heparin, furosemide, and mannitol
5. clamp iliac arteries, then proximal aorta
6. open aneurysm sac opposite IMA, empty of clot, suture lig lumbar arteries
7. Sew in graft with monofilament suture
8. re-establish blood flow
9. Close aneurysm sac and retroperitoneum

Question 3

CEA Steps

Answer 3

1. Arterial line for BP monitoring
2. Anterior to SCM, retracted laterally, identify internal jugular vein, ligate facial vein
3. Expose, preseerving vagus and hypoglossal nerves
4. Heparinize, clamp ICA, CCA, ECA
5. Arteriotomy in CCA extening to ICA
6. endarterectomy, suture tack distally if needed
7. sew in patch, back bleed ICA and ECA
8. Closse, unclamp ECA, CCA, ICA
9. Leave drain in subplatysmal space