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Arm Fistulogram and Cephalic Vein Balloon Angioplasty Sample


PREOPERATIVE DIAGNOSIS:  Left arteriovenous fistula complication.

POSTOPERATIVE DIAGNOSIS:  Left arteriovenous fistula complication.

1.  Diagnostic left arm fistulogram.
2.  Left arm fistula/cephalic vein balloon angioplasty. 

SURGEON:  John Doe, MD

ANESTHESIA:  General MAC and local.



CONTRAST:  Visipaque 10 mL.

INDICATION FOR PROCEDURE:  The patient is a (XX)-year-old male with end-stage renal disease, on hemodialysis. The patient had a left Cimino AV fistula performed in the past with several balloon angioplasties. He developed recurrent stenosis and difficulties with dialysis flow and was recommended the above procedure, which he was agreeable to. The patient was therefore admitted for elective surgery.

PROCEDURE FINDINGS:  Left arm fistulogram showed a mildly severe stenosis, approximately 70-80%, near the arterial anastomosis. Remaining fistula widely patent. No stenosis.

DESCRIPTION OF PROCEDURE:  The patient was brought to the operating room, where he was given general MAC anesthesia, which he tolerated well. Approximately 3 mL of 1% plain Xylocaine was locally infiltrated per Anesthesia. The left arm fistula was percutaneously accessed in retrograde fashion in the upper forearm guiding the guidewire towards the arterial anastomosis at the wrist. Micropuncture set was used.

A 5-French sheath was inserted. The patient was given 3000 units of IV heparin. Tourniquet was applied to the left upper arm and diagnostic left arm fistulogram performed. This revealed the above-noted findings. Given the stenosis, decision made to treat with balloon angioplasty. Bentson guidewire was used to cross the stenosis. Balloon angioplasty performed with a 6 mm diameter x 4 cm balloon. A severe waist was present, which completely effaced with angioplasty up to 6 atmospheres. Angioplasty was done up to 8 atmospheres for 2 minutes twice. Repeat fistulogram showed an excellent result with complete resolution of the stenosis. The tourniquet was released upon completion of fistulogram performed to the upper arm with no significant other problems. The vein was well dilated throughout the remaining length.

Wires and catheters were removed and the sheath was flushed with heparinized saline solution and then removed. Puncture site closed with a 5-0 Prolene stitch. Sterile dressing was placed. The patient tolerated the procedure well without complication and was taken to the recovery room in stable condition. Needle and sponge counts were correct at the end of the procedure.