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

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

Dec 05, 2023 201 likes •265 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

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UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Case Presentation: Emergency Vascular Surgery

Shant M. Vartanian, MD Assistant Professor of Surgery Division of Vascular and Endovascular Surgery

UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Emergency Vascular Surgery

  • 41 year old female brought in by ambulance
  • Massive bright red vaginal bleeding
  • HR 120 SBP 85 Temp 38.4
  • Access, fluids
  • 4U pRBC 4UFFP
  • Vaginal packing
  • To CT scanner

UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

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

UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Emergency Vascular Surgery

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SLIDE 2

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UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Emergency Vascular Surgery

UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

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%

10

UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Emergency Vascular Surgery

UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Emergency Vascular Surgery

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SLIDE 3

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UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Emergency Vascular Surgery

  • Total 12U PRBC, 12U FFP and 2U Plt
  • Coagulopathy reversed, hemodynamically stable
  • Transferred to the floor
  • 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

transfusion

  • Fibrotic skin in groin (presumably from XR)

UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

What would you do?

A. Ilio-femoral bypass B. Angiogram, mechanical thrombolysis

  • C. Fem-fem bypass with bilateral sartorius flaps
  • D. Angiogram, pharmaco-mechanical thrombolysis

0% 0% 0% 0%

10

UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Emergency Vascular Surgery

UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Emergency Vascular Surgery

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SLIDE 4

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UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Emergency Vascular Surgery

UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Emergency Vascular Surgery

UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Emergency Vascular Surgery

UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

Emergency Vascular Surgery

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SLIDE 5

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UC SF

VASCULAR SURGERY • UC SAN FRANCISCO

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