"...his prior A-V fistula was done elsewhere and instead of actually transposing the vein, they superficialized the basilic vein; it was quite medial. The fistula is functioning excellently and looks very good despite the fact that it has infiltrated many times. There is also old forearm loop graft in the same arm, which is thrombosed. He has multiple scars all over this area as the transposition was done in stages. Therefore, we did our best to isolate out the artery at the brachial position just above the antecubital after viewing his old films and records. At this point there was excessive scarring and due to the limitations of the dissection, we isolated out the hood of the prio basilic vein transposition anastomosis as well as the artery deep to this. We dicided to leave the vein hood in place as a point of proximal anastomosis for the arterial end.
Now attention was to the venous end. We made an incision over the axillary vein, more p[roximal vein than had been used prior, to allow for a clean field. The vein was isolated out and vessel loop controlled. The tunnel was created with the Kelly-Wick tunneller from the arterial end to the venous end, lateralizing the graft. We used an atrium taper to 4X6 mm graft and tunnelled it through on the appropriate tunneller. We trimmed it to size and heparinized with 2000 units. Clamp placed on the hood of the old anastomosis and the longitidinal arteriotomy was made. We trimmed the A-V graft and performed the anastomosis using 6-0 prolene.
Now the venous anastomosis was performed. A longitudinal arteriotomy was made in the vein. Old fistula was clamped proximally as well as the graft hada clamp just after the proximal anastomosis to ensure hemostasis. The graft was trimmed to size.
Now we needed to ligate the other A-V access, the basilic vein transposition. We made a counterincision over the old puncture sites, placed two ties and divided it. We still felt somewhat of a pulse and we wanted to ensure that we had in fact ligated the appropriate old basilic vein transposition, so at the incision, near the antecubital area we made a longitudinal incision, dissecting out the A-V fistula once again and ligated it as well as any branches that we saw X2. The old site had so much induration and infiltration of old hemodialysis fix that I decided to leave a wick in between the 2 middle incisions..."
I have no idea-can you help?
- ICD-10 Training
- Exam Preparation
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join