PROCEDURE:  

  1. Right/Left upper extremity AV fistulogram
  2. Central venoplasty
  3. Peripheral venoplasty
  4. Post venoplasty (Right/Left) upper extremity AV fistulogram

 

INDICATION:    

DATE:    

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

MEDICATIONS: Versed     mg IV, fentanyl     mcg IV,     

CONTRAST:     mL of nonionic contrast

FLUOROSCOPY TIME:     minutes

ACCESS:    Right/Left upper extremity AV dialysis graft with ultrasound guidance

COMPLICATIONS: None

 

The risks, benefits, and alternatives to the procedure and sedation were explained.  The specific risk of fistula occlusion and dialysis catheter placement was detailed and accepted. Written informed consent was obtained.  

The patient was assessed for conscious sedation and found to be an adequate candidate. A dedicated nurse monitored heart rate, blood pressure, and oxygen saturation throughout the procedure.

The AV graft and overlying soft tissues were prepped and draped in sterile fashion. Ultrasonographic evaluation of the graft, arterial, and venous anastomoses was performed and an appropriate puncture site chosen. Under ultrasound guidance, the graft was punctured antegrade with a 21 gauge needle. Needle entry was documented and an image stored.  A 0.018″ wire was passed centrally and the needle exchanged for a  transitional dilator.

Diagnostic fistulography was performed from the access point to the right atrium using nonionic contrast.

A 0.035″ Bentson guidewire was manipulated centrally and advanced into the IVC.  The transitional catheter was exchanged for a short 7F sheath.   A 5 French Kumpe catheter was placed over the guidewire and the Bentson was exchanged for a 0.035″ Amplatz guidewire. The Kumpe catheter was removed. The stenosis at the left brachiocephalic vein was dilated sequentially with     balloons. Post venoplasty venography was performed through the sheath. 

The stenosis at the venous anastomosis was then treated sequentially with    balloons. Post venoplasty venography was performed through the sheath.

Finally the AV graft was compressed and the arterial anastamosis was evaluated using nonionic contrast.

The sheath was removed and hemostasis achieved with purse string sutures/_____.

The patient tolerated the procedure well without immediate complications.

 

FINDINGS:

 

IMPRESSION:

 

Successful balloon dilatation of central and venous anastamosis stenoses as described.