DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Chronic renal failure.
POSTOPERATIVE DIAGNOSIS:
Chronic renal failure.
PROCEDURE PERFORMED:
Left Cimino-Brescia arteriovenous fistula.
SURGEON: John Doe, MD
ASSISTANT:
None.
SEDATION:
IV sedation plus local.
COMPLICATIONS:
None.
ESTIMATED BLOOD LOSS:
Nil.
SPECIMENS:
None.
INDICATIONS FOR PROCEDURE:
This is a (XX)-year-old female diagnosed with chronic renal failure approximately a year ago. The patient has had a catheter placed and has been receiving hemodialysis since that time, now presents for Cimino-Brescia arteriovenous fistula placement.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room, placed in the supine position and given IV sedation. The left arm was prepped and draped sterilely.
An incision was created in the medial aspect of the wrist. The subcutaneous tissue was dissected. A sizable cephalic vein was identified and skeletonized over a length of approximately 10 cm. All side branches were ligated with small clips. The radial artery was identified and appeared to be quite small in size. It was approximately 1.6 to 2.2 mm in size despite the large size of the vein. The artery was then skeletonized over a length of approximately 3.5 cm. A small arteriotomy was created after bulldog clamps were applied to occlude the arterial lumen. The vein was occluded proximally with a bulldog clamp. The vein was cut to size. An end-to-side anastomosis was created between the vein and the artery with nitinol U-clips. A total of 13 clips were applied to create a circular anastomosis. Just prior to completion of the anastomosis, 2 coronary dilators were passed both proximally and distally in the artery to be sure there was no evidence of occlusion and the artery was cannulated as well.
The procedure was completed. There were no complications. There was no evidence of bleeding from the anastomosis. The wound was irrigated. The skin was closed with 4-0 Vicryl subcuticular sutures and a sterile dressing was applied. There were no complications.
