uc uc sf sf
play

UC UC SF SF Emergency Vascular Surgery 41 year old female - PowerPoint PPT Presentation

Dec 05, 2023 •201 likes •259 views

UC UC SF SF Emergency Vascular Surgery 41 year old female brought in by ambulance Massive bright red vaginal bleeding Case Presentation: HR 120 SBP 85 Temp 38.4 Emergency Vascular Surgery Access, fluids 4U pRBC

  1. UC UC SF SF Emergency Vascular Surgery • 41 year old female brought in by ambulance • Massive bright red vaginal bleeding Case Presentation: • HR 120 SBP 85 Temp 38.4 Emergency Vascular Surgery • Access, fluids • 4U pRBC 4UFFP • Vaginal packing • To CT scanner Shant M. Vartanian, MD Assistant Professor of Surgery Division of Vascular and Endovascular Surgery VASCULAR SURGERY • UC SAN FRANCISCO VASCULAR SURGERY • UC SAN FRANCISCO UC UC SF SF Emergency Vascular Surgery Emergency Vascular Surgery • Cervical squamous cell carcinoma - Primary inadquately treated with radiation in foreign country - TAH + BSO - Pelvic exenteration - External beam radiation therapy - Periaortic and iliac lymphadenectomy - External beam radiation therapy - Ileal conduit for ureteral strictures - Enterovaginal fistula unresponsive to percutaneous drainage - Enteric bypass and end colostomy • On coumadin for DVT VASCULAR SURGERY • UC SAN FRANCISCO VASCULAR SURGERY • UC SAN FRANCISCO 1

  2. UC UC SF SF Emergency Vascular Surgery What would you do? A. Trans-abdominal exposure, packing, resuscitation in ICU B. Angiogram, covered stent across mycotic aneurysm C. Retroperitoneal exposure, ligation and debridement of extrenal iliac artery, fem-fem bypass 0% 0% 0% VASCULAR SURGERY • UC SAN FRANCISCO VASCULAR SURGERY • UC SAN FRANCISCO 10 UC UC SF SF Emergency Vascular Surgery Emergency Vascular Surgery VASCULAR SURGERY • UC SAN FRANCISCO VASCULAR SURGERY • UC SAN FRANCISCO 2

  3. UC UC SF SF Emergency Vascular Surgery What would you do? A. Ilio-femoral bypass • Total 12U PRBC, 12U FFP and 2U Plt B. Angiogram, mechanical thrombolysis • Coagulopathy reversed, hemodynamically stable • Transferred to the floor C. Fem-fem bypass with bilateral sartorius flaps D. Angiogram, pharmaco-mechanical thrombolysis • POD #2 sudden onset left foot pain and parasthesias • On exam, non-palpable femoral pulse, foot palor, mild parasthesias. - No motor deficit - Monophasic doppler signals • Significant flank and groin edema from massive 0% 0% 0% 0% transfusion • Fibrotic skin in groin (presumably from XR) VASCULAR SURGERY • UC SAN FRANCISCO VASCULAR SURGERY • UC SAN FRANCISCO 10 UC UC SF SF Emergency Vascular Surgery Emergency Vascular Surgery VASCULAR SURGERY • UC SAN FRANCISCO VASCULAR SURGERY • UC SAN FRANCISCO 3

  4. UC UC SF SF Emergency Vascular Surgery Emergency Vascular Surgery VASCULAR SURGERY • UC SAN FRANCISCO VASCULAR SURGERY • UC SAN FRANCISCO UC UC SF SF Emergency Vascular Surgery Emergency Vascular Surgery VASCULAR SURGERY • UC SAN FRANCISCO VASCULAR SURGERY • UC SAN FRANCISCO 4

  5. UC SF Emergency Vascular Surgery • Debridement of infected iliac artery • Irrigation and drainage of pelvic abscess • Wound healed • Converted single remaining surgical drain to pigtail catheter • Resuming tumor surveillance with no evidence of recurrence on last PET/CT • Persistent enterovaginal fistula VASCULAR SURGERY • UC SAN FRANCISCO 5

Recommend

More recommend