TEVAR Procedure Note

Date/Time: [Procedure start time] – [Procedure finish time]

Location: [OR / Hybrid OR / Cath lab]

Primary Operator: [Name, credentials]

Assistant(s)/Fellow/Resident: [Names and roles]

Anesthesia Type: [general / regional / MAC / local]

Diagnoses and Procedures

Preoperative Diagnosis: [Aortic pathology with location and urgency] (Use standard terms: aneurysm, dissection, intramural hematoma, penetrating atherosclerotic ulcer, pseudoaneurysm, traumatic injury. Include segment, laterality, and elective/urgent/emergent status.)

Postoperative Diagnosis: [Same as preoperative / Revised diagnosis if intraoperative discovery]

Procedures Performed:

• [Thoracic endovascular aortic repair (TEVAR)]
• [Adjunct procedures: arch debranching, carotid-subclavian bypass, LSA transposition, branch stenting, iliac conduit, femoral cutdown, percutaneous closure] (List all adjuncts performed.)

Indication: [Rationale for intervention, key imaging findings, anatomic constraints] (Include why now, why TEVAR, relevant measurements, and access/arch anatomy considerations.)

Consent and Safety Checks

[Informed consent obtained / Emergency exception documented]. Time-out performed. [Antibiotic prophylaxis: drug, dose, timing]

Baseline Neurologic Status

[Lower extremity motor function and any pre-existing deficits affecting postoperative exam reliability]

Spinal Cord Protection Strategy

Risk Stratification: [Low / Intermediate / High] (State rationale based on coverage length, prior aortic repairs, hypogastric patency, etc.)

• CSF Drain: [Placed / Not placed] (If placed, include timing and placement details.)
• Target CSF Pressure: [Value] mmHg; Max Drainage: [mL/hour]
• MAP Goal: [Range] mmHg for [duration]
• Intraoperative Neuromonitoring: [SSEP / MEP / None] — [Changes observed]
• Staged Procedure Plan: [If applicable]

(If no prophylactic CSF drain, explicitly state rationale and rescue plan for postoperative neurologic decline: raise MAP, optimize oxygenation/hemoglobin, initiate CSF drainage, urgent imaging, notify surgical team.)

Access and Anticoagulation

Positioning: [Supine / Other position with arm positioning]

• Access Site 1: [Right / Left] [Common femoral / External iliac / Other] — [Percutaneous / Cutdown]. [Sheath size]Fr. Closure: [Method]. Complications: [None / Description with management].
• Access Site 2: [Right / Left] [Vessel] — [Technique]. [Sheath size]Fr. Closure: [Method]. Complications: [None / Description].
• Anticoagulation: Heparin [dose] units. Target ACT [value] sec. Protamine: [None / Partial / Full with dose].

Landing Zones and Aortic Coverage

(Use Ishimaru zone nomenclature. If achieved zones differ from planned, document both with explanation.)

• Proximal Landing Zone: Zone [number]. Landmark: [Anatomic reference]. Sizing diameter: [mm]. Seal length: [mm]. Quality: [Thrombus / Calcification / Dissection flap / Tortuosity / Satisfactory].
• Distal Landing Zone: Zone [number]. Landmark: [Anatomic reference]. Sizing diameter: [mm]. Seal length: [mm]. Quality: [Description].
• Total Coverage: [Length] cm. Intercostal-rich segment involved: [Yes / No].

Arch and Branch Management

• Left Subclavian Artery: [Preserved / Partially covered / Fully covered / Intentionally occluded]. Revascularization: [None / Bypass / Transposition / Chimney / Branched device] — [Same-setting / Staged]. Patency confirmed by [angiography / Doppler / IVUS]. (If covered without revascularization, document rationale.)
• Other Arch Vessels: [No intervention required / Innominate and/or L CCA management details]

Devices and Implants

(List each component. If identifiers unavailable at dictation, state "See implant log" with plan to update.)

• Component 1: [Manufacturer] [Model], [Diameter] × [Length] mm. Lot/UDI: [Identifier]. Delivery: [Route]. Deployment order: [Sequence]. Overlap: [mm].
• Component 2: [Manufacturer] [Model], [Diameter] × [Length] mm. Lot/UDI: [Identifier]. Delivery: [Route]. Deployment order: [Sequence]. Overlap: [mm].

Procedure Description

1. [Access obtained and sheaths placed with wire/sheath details]
2. [Diagnostic aortography and arch branch confirmation with projections and findings]
3. [Wire positioning and true lumen confirmation method] (For dissection cases.)
4. [Deployment sequence with hemodynamic conditions: SBP reduction, rapid pacing, or ventilatory pause]
5. [Balloon molding locations, balloon type/size, and rationale] (If performed.)
6. [Additional extensions and new landing zones] (If applicable.)
7. [Completion imaging performed—see Completion Imaging section]
8. [Access closure, hemostasis achieved, and post-closure pulse assessment]

Completion Imaging

• Endoleak: [None / Type I proximal / Type I distal / Type II / Type III / Type IV] at [location]. Plan: [Immediate reintervention / Observation].
• Target Lesion: [Exclusion confirmed / Residual filling] (E.g., sac not opacified, entry tear excluded.)
• Branch Patency: Innominate [patent / compromised], L CCA [patent / compromised], LSA [patent / compromised / covered], Celiac [patent / compromised] (if near distal edge).
• Graft Configuration: [Satisfactory / Bird-beak / Infolding / Malapposition noted]
• Impression: [Satisfactory result / Additional intervention performed / Planned follow-up]

Findings and Complications

Intraoperative Findings: [Landing zone quality, tortuosity, thrombus burden, dissection flap behavior, access vessel anatomy]

Complications: [None / Description with timing, intervention, and status at case end]

Procedure Totals

• EBL: [mL]
• Contrast: [Type], [volume] mL
• Fluoroscopy Time/Dose: [Values] (Omit if unavailable.)
• Blood Products: [None / Units and types]
• Lines/Drains: [Arterial line / Central line / CSF drain / Other] (If not documented above.)

Postoperative Plan

• Disposition: [ICU / Stepdown] — [Ventilation and hemodynamic status at transfer]
• Hemodynamic Targets: MAP [goal range] mmHg, SBP [upper limit if applicable]. Rationale: [SCI prevention / Endoleak prevention / Other].
• Neurologic Monitoring: [Frequency] neuro checks. Required: [Lower extremity motor strength]. Threshold for concern: [Description]. Rescue protocol: [Raise MAP, optimize Hgb/oxygenation, CSF drain if not present, urgent imaging, notify vascular surgery].
• CSF Drain Protocol: [Target pressure, max drainage, clamp trial plan, positioning restrictions, removal criteria] (If no drain, document contingency plan for neuro change.)
• Access Site Monitoring: [Pulse check and groin exam frequency]
• Medications: [Antiplatelet/anticoagulation plan with timing], [DVT prophylaxis timing], [Antibiotic duration]
• Postoperative Imaging: [CTA timing and indication]