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2011 Planning And Designers Handbook By Max Fajardo

2011 Planning And Designers Handbook By Max Fajardo

pan is an acronym meaning "patient, anatomy, needles, and x-rays." the initial step in this process is to acquire the patient's anatomy, often by noninvasive imaging such as mri/mra. this section of the planning process is critical for proper surgical planning, because each patient's anatomy is different. some patients have dual supply, some have very complex anatomy, and some have relatively simple anatomy. when you have a high suspicion of the anatomy, additional imaging studies can be helpful. if those are inconclusive, then you can consider taking "something off the table," i.e., avoiding certain procedures such as transfemoral access (which is less cosmetically appealing but gives the best exposure to the aorta and arch) or taking a smaller incision, which can increase the risk of infection or bleeding. many anesthesiologists, when asked to determine the best approach to the femoral artery, often say "i'll do it in my own way, that's the way i'll do it." but in general, the first phase of this process involves a very thorough knowledge of anatomy to be sure that the best surgical approach is planned and can be executed with the least amount of risk. at least some noninvasive imaging (e.g., mri/mra) should be performed to identify potential structures that may interfere with access to the anatomy and the aorta. these may include arteries with large diameters that are separate from the aorta and may need to be crossed or be seen in the same planes as the aorta, coronary arteries, lung branches, and large collaterals. when an additional imaging study is negative, then you are ready to start the process of acquiring patient-specific data, which is where the needles and x-ray images come into play. 3d9ccd7d82


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