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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.