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Direct repair of ruptured right femoral anastomotic pseudoaneurysm?

Date: May 18, 2023

Question:

Sudden onset of pulsatile bleeding from rt groin pressure applied rt groin immediately. CT angiogram showed pseudoaneurysm & large hematoma in rt groin. external iliac artery stents. Iliac arteriogram revealed large common femoral patch & patent proximal anastomosis of bypass graft w/o evidence of active extravasation. A stiff Glidewire in aorta & brought over 7 mm balloon into external iliac artery and stent graft portion. Incision was made in the rt groin after staples removed. Immediately a hematoma was evacuated. Opened incision, to femoral artery. This is actually a large dacryon or interposition graft. We followed the graft distally until identified bovine pericardial patch on proximal anastomosis of the bypass graft. Immediately there was pulsatile bleeding from the patch. Proximal & distal control by inflating the balloon to 7 mm & clamping distal bypass graft with a straight PV clamp. This provided adequate control for repair. Two 5-0 Prolene sutures were used to repair bleeding from the patch using figure-of-eight sutures. 

Repair 35860 or 35142?

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