suela923@aol.com
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Would you bill 36147, 35475-74, 75962-74?
Thank you.
Procedure: Right arm fistulogram.
Indication: Difficult access.
Results: Patient was identified and brought to the vascular unit. The right arm was prepped and draped in the usual sterile fashion; 2% lidocaine was used to infiltrate the skin over the right forearm AV fistula and a micropuncture technique was used to access the fistula. Formal fistulogram was performed with the following findings. At the arterial anastomosis and in the right radial artery there is a moderate stenosis. The proximal portion of the graft is irregular. Otherwise the vein in the forearm is of adequate size, caliber, and quality. The veins in the upper arm are patent. Specifically the cephalic vein and basilic vein empty the forearm venous system adequately. There is irregularity to the right subclavian vein but there is excellent collateral flow filling the superior vena cava. An attempt was made to cross the proximal radial artery stenosis; however, this was unsuccessful due to significant tortuosity.
IMPRESSION:
Patent right arm AV fistula. Significant stenosis at the right radial artery anastomosis. The patient will require surgical revision as this could not be treated endovascularly.
Thank you.
Procedure: Right arm fistulogram.
Indication: Difficult access.
Results: Patient was identified and brought to the vascular unit. The right arm was prepped and draped in the usual sterile fashion; 2% lidocaine was used to infiltrate the skin over the right forearm AV fistula and a micropuncture technique was used to access the fistula. Formal fistulogram was performed with the following findings. At the arterial anastomosis and in the right radial artery there is a moderate stenosis. The proximal portion of the graft is irregular. Otherwise the vein in the forearm is of adequate size, caliber, and quality. The veins in the upper arm are patent. Specifically the cephalic vein and basilic vein empty the forearm venous system adequately. There is irregularity to the right subclavian vein but there is excellent collateral flow filling the superior vena cava. An attempt was made to cross the proximal radial artery stenosis; however, this was unsuccessful due to significant tortuosity.
IMPRESSION:
Patent right arm AV fistula. Significant stenosis at the right radial artery anastomosis. The patient will require surgical revision as this could not be treated endovascularly.