ksb0211
Guest
I'm not entirely sure of how to bill this out. Hoping for any suggestions.
Thanks.
PRE/POSTOPERATIVE DIAGNOSIS
1. Chronic renal failure.
2. Thrombosed fistula, left upper extremity.
OPERATION PERFORMED
Revision of venous access with Activase thrombolysis
DESCRIPTION OF PROCEDURE
The patient was prepped with DuraPrep and draped sterilely after induction of adequate general anesthesia. The incision was opened in the left forearm. Some significant adhesions occurred since the surgery of 6 days ago. I was able to control the thrombosed vein and then ultimately the inflow and outflow of the brachial artery and radial artery. With this completed, the patient was heparinized with 7000 units of intravenous heparin. The patient had a significant vein where there was confluence point just above the anastomosis. This was amputated and the embolectomy catheter was passed. Following this, I inflated the balloon and injected with 3 mL of Activase. This kept it in location of the clot. Ultimately, then I was able to perform an embolectomy with no further clot identified. Thorough flushing was utilized. The proximal thrombectomy was performed utilizing similar technique. Once this was completed, I did have a fenestration of the vein to allow for removal of the clot. The vein patch was applied to widen the lumen in that site. The vein patch was taken from the small branch that had been amputated. It was secured in place with running 7-0 Prolene suture. At the termination of the procedure, I was able to appreciate a bruit. Blood pressure was 100 systolic range with only minimal thrill noted. The patient will be maintained on anticoagulation and plan will be for followup duplex scan in the a.m.
Thanks.
PRE/POSTOPERATIVE DIAGNOSIS
1. Chronic renal failure.
2. Thrombosed fistula, left upper extremity.
OPERATION PERFORMED
Revision of venous access with Activase thrombolysis
DESCRIPTION OF PROCEDURE
The patient was prepped with DuraPrep and draped sterilely after induction of adequate general anesthesia. The incision was opened in the left forearm. Some significant adhesions occurred since the surgery of 6 days ago. I was able to control the thrombosed vein and then ultimately the inflow and outflow of the brachial artery and radial artery. With this completed, the patient was heparinized with 7000 units of intravenous heparin. The patient had a significant vein where there was confluence point just above the anastomosis. This was amputated and the embolectomy catheter was passed. Following this, I inflated the balloon and injected with 3 mL of Activase. This kept it in location of the clot. Ultimately, then I was able to perform an embolectomy with no further clot identified. Thorough flushing was utilized. The proximal thrombectomy was performed utilizing similar technique. Once this was completed, I did have a fenestration of the vein to allow for removal of the clot. The vein patch was applied to widen the lumen in that site. The vein patch was taken from the small branch that had been amputated. It was secured in place with running 7-0 Prolene suture. At the termination of the procedure, I was able to appreciate a bruit. Blood pressure was 100 systolic range with only minimal thrill noted. The patient will be maintained on anticoagulation and plan will be for followup duplex scan in the a.m.
