Any suggestions:
SERVICES PROVIDED:
1. Stent graft deployment across a right upper arm cephalic vein pseudoaneurysm. 2. Diagnostic fistulogram. 3.
Intravenous moderate sedation.
DAP:
1395.4 cGy cm2.
CONTRAST:
115 mL Omnipaque 300.
FLUOROSCOPY TIME:
147 minutes.
COMPARISON:
10/11/2010
PROCEDURE/METHODS:
The procedure was explained in detail to the patient and patient's family member. Potential risks, benefits, and alternate therapies were discussed.
All questions were answered and informed consent was obtained.
IV moderate sedation was given throughout the procedure using IV Versed and fentanyl. The patient was monitored with automatic blood pressure cuff measurement, EKG, and pulse oximetry throughout the procedure. Medications were administered by an RN under the direct supervision of the IR attending.
Prophylactic IV antibiotics were given to the patient.
Patient's right arm was examined with ultrasound. The right arm was sterilely scrubbed, prepped and draped in the standard fashion. Local anesthetic was applied using 2% Xylocaine. Using ultrasound guidance and a micropuncture needle, access was gained into the cephalic vein just proximal to the large pseudoaneurysm. The percutaneous access was dilated to accept a 12-French introducer sheath which was guided over a wire into the cephalic vein. A diagnostic fistulogram was obtained with multiple views of the aneurysm and aneurysm neck. After measurements were obtained, a 12-mm in diameter by 50-cm long covered stent graft was positioned and deployed across the neck of the aneurysm. Post stenting and angioplasty with a 10-mm balloon venography was performed showing persistent flow into the aneurysm along the more central aspect of the covered stent graft.
A second covered stent graft was then deployed into the first stent graft and the stent graft was angioplastied with a
10- followed by a 12-mm balloon. Postangioplasty and poststenting fistulogram was performed.
Following plasty with the 12-mm balloon, there is no further evidence of leakage around the stent graft or into the aneurysm.
Using ultrasound guidance and a micropuncture needle, access was gained into the pseudoaneurysm. Percutaneous access was dilated to accept a 5-French catheter. Under direct ultrasound observation, blood from the aneurysm was aspirated. Catheters were removed and overlying hemostasis achieved using 2-0 nylon suture in a purse string manner.
The suture was removed before the patient was discharged from the IR suite.
The patient tolerated the procedure well without complication.
Patient left the IR suite in stable condition without evidence of bleeding.
FINDINGS:
The fistulogram shows a large aneurysm arising from the proximal cephalic vein near the surgical neck of the humerus.
Following deployment of two stent grafts and angioplasty with a 12-mm balloon, the post and final fistulogram shows no further evidence of leakage into the aneurysm.
IMPRESSION 1.
SUCCESSFUL OCCLUSION OF A LARGE PSEUDOANEURYSM ARISING FROM A RIGHT UPPER ARM CEPHALIC VEIN ARTERIOVENOUS FISTULA.
2.
SPECIAL INSTRUCTIONS FOR DIALYSIS CENTER NOT TO PUNCTURE THE STENTED SEGMENT OF THE CEPHALIC VEIN WITHIN THE UPPER HALF OF THE RIGHT UPPER ARM TO ALLOW HEALING.
Thanks so much to anyone that can help me with these.
SERVICES PROVIDED:
1. Stent graft deployment across a right upper arm cephalic vein pseudoaneurysm. 2. Diagnostic fistulogram. 3.
Intravenous moderate sedation.
DAP:
1395.4 cGy cm2.
CONTRAST:
115 mL Omnipaque 300.
FLUOROSCOPY TIME:
147 minutes.
COMPARISON:
10/11/2010
PROCEDURE/METHODS:
The procedure was explained in detail to the patient and patient's family member. Potential risks, benefits, and alternate therapies were discussed.
All questions were answered and informed consent was obtained.
IV moderate sedation was given throughout the procedure using IV Versed and fentanyl. The patient was monitored with automatic blood pressure cuff measurement, EKG, and pulse oximetry throughout the procedure. Medications were administered by an RN under the direct supervision of the IR attending.
Prophylactic IV antibiotics were given to the patient.
Patient's right arm was examined with ultrasound. The right arm was sterilely scrubbed, prepped and draped in the standard fashion. Local anesthetic was applied using 2% Xylocaine. Using ultrasound guidance and a micropuncture needle, access was gained into the cephalic vein just proximal to the large pseudoaneurysm. The percutaneous access was dilated to accept a 12-French introducer sheath which was guided over a wire into the cephalic vein. A diagnostic fistulogram was obtained with multiple views of the aneurysm and aneurysm neck. After measurements were obtained, a 12-mm in diameter by 50-cm long covered stent graft was positioned and deployed across the neck of the aneurysm. Post stenting and angioplasty with a 10-mm balloon venography was performed showing persistent flow into the aneurysm along the more central aspect of the covered stent graft.
A second covered stent graft was then deployed into the first stent graft and the stent graft was angioplastied with a
10- followed by a 12-mm balloon. Postangioplasty and poststenting fistulogram was performed.
Following plasty with the 12-mm balloon, there is no further evidence of leakage around the stent graft or into the aneurysm.
Using ultrasound guidance and a micropuncture needle, access was gained into the pseudoaneurysm. Percutaneous access was dilated to accept a 5-French catheter. Under direct ultrasound observation, blood from the aneurysm was aspirated. Catheters were removed and overlying hemostasis achieved using 2-0 nylon suture in a purse string manner.
The suture was removed before the patient was discharged from the IR suite.
The patient tolerated the procedure well without complication.
Patient left the IR suite in stable condition without evidence of bleeding.
FINDINGS:
The fistulogram shows a large aneurysm arising from the proximal cephalic vein near the surgical neck of the humerus.
Following deployment of two stent grafts and angioplasty with a 12-mm balloon, the post and final fistulogram shows no further evidence of leakage into the aneurysm.
IMPRESSION 1.
SUCCESSFUL OCCLUSION OF A LARGE PSEUDOANEURYSM ARISING FROM A RIGHT UPPER ARM CEPHALIC VEIN ARTERIOVENOUS FISTULA.
2.
SPECIAL INSTRUCTIONS FOR DIALYSIS CENTER NOT TO PUNCTURE THE STENTED SEGMENT OF THE CEPHALIC VEIN WITHIN THE UPPER HALF OF THE RIGHT UPPER ARM TO ALLOW HEALING.
Thanks so much to anyone that can help me with these.