2013 夏

夏天來了
討厭ㄋㄟ
減重尚未成功

NTUH 2013 Advanced Complex Aortic Surgery (Observer)

May 7th  dear, do you get my point
        AAA stenting
        supra-inguinal incision, above inguinal skin fold, parallel up 1 cm
        make sure explore CFA, do not show bifurcation of CFA
        purse-string the puncture hole
        snare CFA both proximal and distal end
        cook long sheath at contralateral leg to help cannulation/engage
        side-puncture the cook long sheath, help engage
        contrast injection ( 35/15 , 35/20 ) (generally 15/20)
        magnify critical point of landing (renal, internal iliac)
        retain contrast in sheath, then push heparin saline instead of contrast
        this will decrease contrast amount used
        favor 3 piece configuration
        make sure every vessel is fine by doppler (Hu Hu Jao)
        completion angiogram: show the empty zone b/w the legs

May 8th dear, do you get my point / water deep
        TEVAR with CCS bypass
        right neck longitudinal incision
        left neck horizontal incision
        TAG via right CFA (skin vertical incision)
        diagnostic sheath via left CVA puncture
        CC bypass first then CS bypass
        SCA bypass use graft (not transposition)
        graft end to SCA side anastomosis
        graft end to LCCA end anastomosis (transection LCCA, suture ligation proximal stump)
        diagnostic sheath and pigtail via RCCA
        to protect innominate aretry ostium in case covered by TAG
        deploy 2 piece TAG overlapping each other
        vascular plug via left brachial artery sheath, (conter-clockwise rotation GW to disconnect)
    
        dissection of right CIA with flow limitation
        saved with cross-over stenting Medtronic complete SE iliac stent (bare metal stent)
        resume of right leg flow