DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
End-stage renal disease and need for hemodialysis.
POSTOPERATIVE DIAGNOSIS:
End-stage renal disease and need for hemodialysis.
PROCEDURE PERFORMED:
Left radial to antebrachial side-to-side fistula at the left antecubital fossa.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
COMPLICATIONS: None.
INDICATIONS FOR PROCEDURE: The patient presented with end-stage renal disease. She has a need for hemodialysis. Risks and benefits of the procedure were explained to the patient, and she was agreeable to proceed with surgery. Informed consent was obtained. The patient underwent venous mapping of the left upper extremity. The cephalic vein at the distal forearm measured around 1.8 mm. The patient had palpable radial and ulnar pulses. She had codominant superficial palmar arch. The recommendation for proximal radial fistula was given. The patient was agreeable to proceed with radial to antebrachial side-to-side fistula.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed on the table in the supine position. General endotracheal anesthesia was given to the patient without any problem. The left upper extremity was prepped and draped in the usual sterile fashion.
A longitudinal incision was made in the left antecubital fossa. The incision was carried down through the skin and subcutaneous tissue. The antebrachial vein was identified. The deep venous branch was identified. The cephalic vein was identified. The antebrachial vein was dissected. Side branches were ligated. The radial artery was isolated. The side branches were doubly clipped and divided. Vessel loops were placed around the vessels. A longitudinal venotomy was performed. A 2.5 mm dilator was used to destroy the valve of the antebrachial vein between the antecubital fossa and the wrist. Both venous lumens were flushed with saline solution. The radial artery was then clamped between 2 clamps. Longitudinal arteriotomy was performed. Side-to-side anastomosis with 7-0 Prolene was performed. Flow was restored through the vein without any problem. The patient had a nice palpable thrill in proximal cephalic vein. The patient had a nice thrill and flow signal in the antebrachial vein toward the wrist. Due to competitive flow, the deep venous branch was ligated at the antecubital fossa.
The subcutaneous tissue was closed with running 3-0 Vicryl. The skin was closed with running 4-0 Vicryl. Steri-Strips were applied to the skin. A 4 x 4 and Tegaderm were applied to the left antecubital fossa. The patient tolerated the procedure well, was extubated in the operating room and was sent to the recovery room in stable condition.
