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Radiology.Academy.Sk

IR Fistulogram w/ Angioplasty

History/Indication for procedure: 65-year-old dialysis dependent man presents to
the TAMC interventional radiology clinic for evaluation of fistula dysfunction.

Procedure:
1. Fistulogram of left brachiobasilic fistula.
2. Percutaneous angioplasty of proximal venous outflow tract.

Physicians:

Complications: None.

Medications:
1. 1% lidocaine local.
2. 0.5 mg Versed IV.
3. 75 mcg fentanyl IV.

Contrast: 40 mL Omnipaque 300 nonionic contrast, intravenous.

Operative Note And Findings:
The patient was counseled as to the risks, benefits, and alternatives to the
procedure, and opted to proceed. Oral and written consent were obtained. The
patient was placed supine on the interventional radiology table. Sedation was
administered, the patient's state of consciousness and vital signs were
monitored throughout the entire procedure, and sedation was discontinued at the
conclusion of the procedure by the sedation nurse.

The patient's left-sided brachiobasilic was evaluated by ultrasound. An
appropriate venous access was obtained approximately 5 cm central to the
anastomosis. Central venograms were performed, demonstrating no significant
stenosis. A reflux venogram demonstrated multiple areas of stenosis within the
proximal venous outflow tract.

The more central basilic vein was accessed using a 5 French micropuncture kit
under ultrasound guidance. The access was upsized using a 6 French vascular
sheath over an 80 cm 0.035 inch Amplatz wire. A 7 mm x 4 cm P3 angioplasty
balloon was then advanced to the stenotic region over 145 cm 0.035 inch Coons
wire. The balloon was inflated to its maximum pressure, without resolution of a
single waist within the basilic vein. The balloon was then exchanged for a 7 mm
x 4 cm conquest angioplasty balloon which was brought to profile with resolution
of the focal stenosis. Post angioplasty venograms demonstrate significantly
improved visualization of the venous outflow tract, with no significant stenosis
identified and resultant robust thrill in the fistula.

The 2 access sites were closed using purse-string sutures with 2-0 Prolene. The
patient tolerated the procedure well, and was transferred to the recovery unit
in good condition. There were no complications.

Impression: Status post left brachiobasilic fistulogram and angioplasty of
stenosis of proximal left basilic vein with excellent result.

Plan:
1. Standard recovery. Fistula ready to use.
2. Patient will have dialysis at TAMC tomorrow, 22 Oct 2013. IR will remove
purse-string sutures at this time.