Patient Name:
DOB: SEX:
Ordering Physician:
Procedure: Percutaneous AV graft thrombectomy, balloon dilatation of the venous outflow tract
Indication: Thrombosed AV graft.
Date:
Operators: John Doe, MD (Attending)/Jane Doe, MD (Fellow)
Medications: mgs IV Versed, mcg IV fentanyl, units IV heparin, . 4 mg intragraft tPA
Contrast: cc s nonionic
Fluoroscopy time: minutes
Access sites: F sheath antegrade with ultrasound and 6 F sheath retrograde via
Balloons: mm x 4 cm Conquest
Complications: None significant.
The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. The specific risks of arterial embolization and pulmonary emboli were 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 patient denied contraindications to thrombolytic therapy.
Technique:
The thrombosed graft and overlying soft tissues were prepped and draped in sterile fashion. Ultrasonographic evaluation was carried out. Using local anesthetic and ultrasound guidance, the graft was punctured antegrade near the arterial anastomosis and an image transferred the PACS. A 0.018″ wire was passed centrally and the needle exchanged for a 5 French transitional dilator. A minimal contrast injection was made with occlusion of the native artery inflow, confirming complete thrombosis.
A 0.035-inch Glidewire was negotiated centrally and the dilator exchanged for a 6 French short sheath. 4 mg t-PA in 20 cc saline were injected through the sheath into the thrombosed graft with manual occlusion of both the native artery and outflow vein. A Fogarty balloon was passed over the wire antegrade into the central veins. A small contrast injection was made, identifying areas of stenosis.
An ____ mm x 4 cm Conquest balloon was advanced to the sites of stenosis and inflated. Contrast evaluation was performed.
Using technique, the graft was accessed retrograde with a 21 gauge needle. A 6 French sheath was placed.
An angled catheter and Glidewire were negotiated into the native artery. The Fogarty was placed over the wire and the balloon pulled across the arterial anastomosis to remove the platelet plug. The arterial anastomosis was evaluated.
Purse-string closure of the retrograde graftotomy was performed, achieving immediate hemostasis.
Evaluation of the entire graft was performed through the antegrade puncture with imaging to the level the right atrium.
The antegrade graftotomy was closed ______ .
The procedure was well tolerated, and patient discharged in satisfactory condition.
Findings:
- The upper arm AV graft is thrombosed.
Impression:
Successful percutaneous graft thrombectomy, ____ upper arm AV graft.
A thrill was restored to the graft.