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Procedure Performed:
Ultrasound-guided access of the arteriovenous (AV) fistula right upper extremity
Right upper extremity AV fistulogram
Right brachial artery anastomotic angioplasty with a 4 x 40 mm balloon
Right upper arm AV graft angioplasty with a 7 mm balloon
Right brachial vein percutaneous angioplasty with a 12 x 40 mm balloon
Right subclavian vein and superior vena cava angioplasty with a 10 x 40 mm balloon
Upon identification of the patient, the patient is kept supine on the operating table. Standard sterile preparations were done after sedation with 2 mg of Versed. Local anesthesia given with 1% lidocaine. The patient had an AV graft between the right brachial artery and the right brachial vein. We accessed the Gore-Tex graft with an unltrasound using SonoSite. Unltrasound has shown the AV graf is alomost totally occluded. I accessed that with a micropuncture needle, then changes that to a 7-French Prelude sheath. I introducted 2 sheaths, 1 facing towards the arterial anastomosis and the other towards the venous anastomosis. Systemic anticoagulation was given with IV heparin. An AV fistulogram has showed almost subtotal occlusion of the entire graft. There is a very tiny string of the flow going in the graft. At this point, I cannulated the arterial anastomosis, which is the Gore-Tex graft to the brachial artery, did an angioplasty with a 4 x 40 mm balloon, and this provided enough inflow into the graft. Then, the entire graft was angioplastied with a 7 mm balloon. The venous anastomosis into the brachial vein has a stent in place. There is intrastental stenosis, and I did an angioplasty of the intrastental stenosis with a 12 x 40 balloon. After that, the patient has a fractured stent right at the junction of the right subclavian vein and superior vena cava. With the fracture, we managed ti cross the fracture and did an complete reopening of the entire AV graft. The arterial inflow is good and outflow is good as well. The subclavian superior vena cava stenosis is almost fixed, except residual 10%-20%.
coding assistance is appreciated.
Procedure Performed:
Ultrasound-guided access of the arteriovenous (AV) fistula right upper extremity
Right upper extremity AV fistulogram
Right brachial artery anastomotic angioplasty with a 4 x 40 mm balloon
Right upper arm AV graft angioplasty with a 7 mm balloon
Right brachial vein percutaneous angioplasty with a 12 x 40 mm balloon
Right subclavian vein and superior vena cava angioplasty with a 10 x 40 mm balloon
Upon identification of the patient, the patient is kept supine on the operating table. Standard sterile preparations were done after sedation with 2 mg of Versed. Local anesthesia given with 1% lidocaine. The patient had an AV graft between the right brachial artery and the right brachial vein. We accessed the Gore-Tex graft with an unltrasound using SonoSite. Unltrasound has shown the AV graf is alomost totally occluded. I accessed that with a micropuncture needle, then changes that to a 7-French Prelude sheath. I introducted 2 sheaths, 1 facing towards the arterial anastomosis and the other towards the venous anastomosis. Systemic anticoagulation was given with IV heparin. An AV fistulogram has showed almost subtotal occlusion of the entire graft. There is a very tiny string of the flow going in the graft. At this point, I cannulated the arterial anastomosis, which is the Gore-Tex graft to the brachial artery, did an angioplasty with a 4 x 40 mm balloon, and this provided enough inflow into the graft. Then, the entire graft was angioplastied with a 7 mm balloon. The venous anastomosis into the brachial vein has a stent in place. There is intrastental stenosis, and I did an angioplasty of the intrastental stenosis with a 12 x 40 balloon. After that, the patient has a fractured stent right at the junction of the right subclavian vein and superior vena cava. With the fracture, we managed ti cross the fracture and did an complete reopening of the entire AV graft. The arterial inflow is good and outflow is good as well. The subclavian superior vena cava stenosis is almost fixed, except residual 10%-20%.
coding assistance is appreciated.