PROCEDURE: 

  1. AV fistulogram
  2. Venous angioplasty

 

CLINICAL HISTORY: Patient is a _____ with history of end-stage renal disease and prior AV fistula placement. Patient with abnormal pressures during dialysis.

DATE OF PROCEDURE:    

OPERATORS:  John Doe, MD (Attending)/Jane Doe, MD (Fellow)     

MEDICATIONS:  Versed     mg IV, Fentanyl      ug IV, Heparin     units IV

CONTRAST:     cc  Visipaque 320

COMPLICATION: None.

PROCEDURE:

The risks and benefits and alternatives of the procedure as well as conscious sedation were discussed with the  ______  . After obtaining informed consent the patient was prepped and draped in the usual sterile fashion.

The skin and subtends tissue overlying the AV fistula was infiltrate with 1% lidocaine without epinephrine. The AV fistula was accessed towards the venous side utilizing a micropuncture technique. Multiple injections were made through the transitional dilator with imaging of the     upper extremity and centrally. The venous end was then manually compressed and repeat contrast injection through the transitional dilator was performed to visualize the remainder of the AV fistula and the arterial anastomosis. The dilator was then removed over a 0.035 Bentson wire and a 6 French short sheath was placed. A 6 mm by 4 cm Conquest balloon was then passed over the wire and used to dilate the multiple areas of stenosis throughout the venous outflow tract. Next, a 8 mm x 4 cm Conquest balloon was then passed over the wire and used to redilate the area of stenosis. The images were reviewed. The sheath was then removed and hemostasis achieved utilizing manual compression. Sterile dressing was applied.

The patient tolerated the procedure well and left the angiography suite in stable condition without any immediate postprocedural multiple areas of stenosis complications.

 

FINDINGS: Multiple areas of stenosis throughout the venous outflow tract, which  is the cephalic vein. No evidence of central stenosis. No evidence of stenosis and at the arterial anastomosis.

 

INTERVENTION: Venoplasty of the venous outflow track with a 6 mm by 4 cm balloon and a 8 mm x 4 cm balloon. Post venoplasty, no evidence of residual stenosis.

 

IMPRESSION:

  1. Multiple areas of stenosis throughout the venous outflow tract, which was successfully dilated. No residual stenosis was identified after balloon angioplasty.