EVAR Procedure Note (Infrarenal AAA)

Date of Procedure: [Date]

Procedure Start/End Time: [Start time] – [End time]

Location: [OR / Hybrid suite / Cath lab]

Primary Operator: [Name, credentials]

Assistant(s)/Co-surgeon: [Name(s), credentials, or "None"]

Service: [Vascular Surgery / Interventional Radiology / Cardiology / Other]

Diagnoses and Indication

Preoperative Diagnosis: [Preoperative diagnosis]

Postoperative Diagnosis: [Postoperative diagnosis] (Must be explicitly stated; do not assume same as preoperative)

Procedure(s) Performed:

• [Codable procedure phrase]
• [Additional procedure] (One procedure per line; include all procedures that materially occurred)

Indication: [2–4 sentence rationale for EVAR including AAA maximum diameter, symptom status, and anatomic suitability factors]

Pre-Procedure Verification

• Informed consent obtained from [patient / surrogate with relationship]
• Time-out performed per institutional protocol
• Antibiotic prophylaxis: [Agent, dose, timing] (May reference anesthesia record)

Anesthesia and Anticoagulation

Anesthesia Type: [General / Regional / MAC / Local with sedation]

Heparin: [Dose and time administered; include redosing if applicable]

Activated Clotting Time (ACT): Target [target value]; Intraoperative values [values and times]

Reversal: [Protamine dose and time / Not given]

[Significant hemodynamic events affecting procedural conduct] (Only include if occurred; do not duplicate full anesthesia record)

Preoperative Sizing Summary

Imaging Source: [Modality] dated [Date] (If numeric values unavailable, state "Refer to sizing worksheet or CTA report")

• Proximal neck: Diameter [mm], Length [mm], Angulation [degrees if relevant], Morphology [thrombus/calcification if documented]; Source: [CTA / IVUS / Angio]
• Lowest renal artery reference: [Right / Left / Accessory renal]
• Maximum aneurysm diameter: [mm]; Source: [CTA / IVUS / Angio]
• Iliac landing zones: Right [CIA/EIA], [diameter mm], [length mm]; Left [CIA/EIA], [diameter mm], [length mm]
• Access vessel assessment: Right: [diameter mm], calcification [none/mild/moderate/severe], tortuosity [none/mild/moderate/severe]; Left: [diameter mm], calcification [none/mild/moderate/severe], tortuosity [none/mild/moderate/severe]; Conduit required: [Yes/No]

Vascular Access

Right Groin Access

• Access site: [Right CFA / SFA / Iliac conduit]
• Access method: [Percutaneous with ultrasound guidance / Surgical cutdown]
• Sheath: [Size Fr, type/brand]
• Closure strategy: [Preclose device type and number / Open surgical repair]

Left Groin Access

• Access site: [Left CFA / SFA / Iliac conduit]
• Access method: [Percutaneous with ultrasound guidance / Surgical cutdown]
• Sheath: [Size Fr, type/brand]
• Closure strategy: [Preclose device type and number / Open surgical repair]

Additional Access

(Include only if used; omit entire subsection if not applicable)

• Access site: [Brachial / Axillary / Iliac conduit / Other with laterality]
• Access method and sheath: [Method, size Fr]
• Closure: [Closure strategy or removal technique]

Implants and Components

Endograft System: [Manufacturer] [Model]

Implant identifiers: [Recorded in separate implant log / Listed below with lot/serial/UDI]

• Main body: [Diameter] × [Length] mm; Delivery side: [Right / Left]
• Contralateral limb: [Diameter] × [Length] mm; Side: [Right / Left]
• Iliac extension(s): [Side], [Landing vessel: CIA/EIA], [Diameter] × [Length] mm (Add lines as needed; omit if none)
• Aortic cuff(s): [Diameter] × [Length] mm (Omit if none)
• Ancillary devices: [Device type, target vessel, size, quantity] (Omit if none)

(Device type and size are mandatory; use completion-forcing placeholders if unknown at dictation)

Procedure Description

(Describe in chronological order using precise anatomic terminology with natural paragraph breaks between major steps; omit subsections for interventions not performed)

[Initial access, wire/catheter placement, and baseline aortography findings including renal artery patency, aneurysm morphology, and iliac anatomy]

[Main body positioning relative to lowest renal artery, confirmation of proximal seal zone, and deployment details]

[Contralateral gate cannulation technique and wire/catheter choices]

[Limb deployment with overlap lengths and distal landing zone details]

[Balloon molding if performed: device and segments treated]

[Adjunctive interventions if performed: iliac angioplasty/stenting, hypogastric management, cuffs, endoanchors, endoleak management]

Completion Imaging and Endoleak Assessment

Completion angiography: [Performed / Limited: specify limitation / Not performed: specify reason and early imaging plan]

• Renal arteries: [Bilateral patent / Other finding]
• Endograft limbs: [Both limbs patent with flow to femoral systems / Other finding]
• Hypogastric arteries: [Patent bilaterally / Intentional coverage (side) / Embolized (side)]

Endoleak assessment: [No endoleak visualized / Endoleak present: Type Ia/Ib/II/IIIa/IIIb/IV/V with feeding vessel(s) if Type II]

[If endoleak present: intraoperative management, residual status at case end, and rationale if left untreated] (Do not infer endoleak status; must be documented from completion imaging)

Access Site Closure

Right Groin

• Closure method: [Device name/size and number / Surgical repair technique]
• Hemostasis confirmation: [Manual pressure / Angiographic check / Direct visualization]
• Vascular exam: [DP/PT pulses or Doppler signals]; Groin: [Hemostatic / Hematoma / Oozing]
• Complications: [None / Description and management]

Left Groin

• Closure method: [Device name/size and number / Surgical repair technique]
• Hemostasis confirmation: [Manual pressure / Angiographic check / Direct visualization]
• Vascular exam: [DP/PT pulses or Doppler signals]; Groin: [Hemostatic / Hematoma / Oozing]
• Complications: [None / Description and management]

Procedural Metrics

Estimated Blood Loss: [mL]

Total Contrast Volume: [mL] (Or "pending import from imaging system")

Fluoroscopy Time: [minutes] (Or "pending import")

Radiation Dose: [Reference air kerma / DAP / Peak skin dose with units] (Or "pending import")

(Fluids and blood products per anesthesia record)

Complications

(Include only if intraoperative complications occurred; otherwise omit entire section)

[Complication description, immediate management, patient response, and whether conversion to open repair was required. Ensure unplanned procedures are listed in Procedures Performed above.]

Disposition and Postoperative Plan

Disposition: [PACU / ICU / Floor]; Hemodynamics: [Stable / Other]; Airway: [Extubated / Intubated]

Postoperative orders:

• Neurovascular and groin checks: [Frequency]
• Activity: [Bedrest duration, HOB restrictions if applicable]
• Renal monitoring: [BMP/creatinine timing; hydration plan if applicable]
• Antithrombotic: [Antiplatelet therapy; DVT prophylaxis]
• Blood pressure: [Goals and parameters if specified]

Postoperative Imaging Plan:

• Baseline CTA abdomen/pelvis at [~1 month]
• If baseline normal: Duplex ultrasound at 12 months and annually; Cross-sectional imaging every 5 years
• Earlier imaging triggers: Suspected endoleak, sac enlargement, graft migration, limb stenosis/occlusion, new symptoms
• [If endoleak at case end: Tailored surveillance interval and specific reintervention thresholds] (Do not use vague follow-up language)

Attestation

Surgeon Signature: ________________________________ Date/Time: [Date and time]

Attending Attestation: [Attestation statement per institutional requirements] (Include only if trainee participated)

Trainee Participation: [Role and level of involvement] (Include only if applicable)