ksb0211
Guest
Any thoughts on this one? Would is just be a revision? I'm going back and forth and any thoughts would be greatly appreciated...
PREOPERATIVE DIAGNOSIS
Pseudoaneurysmal dilatation of cephalic vein arteriovenous fistula.
POSTOPERATIVE DIAGNOSIS
Pseudoaneurysmal dilatation of cephalic vein arteriovenous fistula.
OPERATION PERFORMED
Excision of thrombosed pseudoaneurysmal cephalic vein for AV fistula.
Size of these masses were 8 cm and 7 cm.
DESCRIPTION OF PROCEDURE
The patient was brought to the operating room after attainment of sufficient general anesthesia, she was pretreated with antibiotics and prepped and draped in the usual sterile fashion. Made 2 elliptical incisions, these thrombosed areas of her fistula on the right upper extremity looked almost like a dromedary camel with two very large humps. We made elliptical incisions about each of them and they were connected by relatively narrow isthmus. Removed each one independently using sharp dissection and then Bovie and then ligating off the nonfunctional fistula, both proximally and distally. We excised both of these areas, one was about 8 cm and the other was about 7, and using an 0 silk ligature on the superior aspect of the fistula. Once that was done, we irrigated both sites. We closed with deep sutures of 2-0 Vicryl followed by subcutaneous sutures of 3-0 Vicryl followed by skin staples. We injected with Marcaine at the beginning of the case and then again at the end. She tolerated the procedure well.
PREOPERATIVE DIAGNOSIS
Pseudoaneurysmal dilatation of cephalic vein arteriovenous fistula.
POSTOPERATIVE DIAGNOSIS
Pseudoaneurysmal dilatation of cephalic vein arteriovenous fistula.
OPERATION PERFORMED
Excision of thrombosed pseudoaneurysmal cephalic vein for AV fistula.
Size of these masses were 8 cm and 7 cm.
DESCRIPTION OF PROCEDURE
The patient was brought to the operating room after attainment of sufficient general anesthesia, she was pretreated with antibiotics and prepped and draped in the usual sterile fashion. Made 2 elliptical incisions, these thrombosed areas of her fistula on the right upper extremity looked almost like a dromedary camel with two very large humps. We made elliptical incisions about each of them and they were connected by relatively narrow isthmus. Removed each one independently using sharp dissection and then Bovie and then ligating off the nonfunctional fistula, both proximally and distally. We excised both of these areas, one was about 8 cm and the other was about 7, and using an 0 silk ligature on the superior aspect of the fistula. Once that was done, we irrigated both sites. We closed with deep sutures of 2-0 Vicryl followed by subcutaneous sutures of 3-0 Vicryl followed by skin staples. We injected with Marcaine at the beginning of the case and then again at the end. She tolerated the procedure well.