Lisa Posted Tue 28th of April, 2020 21:08:11 PM
IS CATHETER PLACEMENT INCLUDED :
We visualized the right brachiobasilic fistula with ultrasound and found that it was patent. Then, under direct ultrasound visualization and guidance, we punctured the right brachiobasilic fistula near the venous anastomosis. Images were taken and archived. We then used modified Seldinger's technique to insert a 4 French outer diameter sheath. We performed an angiogram of the right brachiobasilic fistula. The right brachiobasilic fistula was 50% stenosed . at junction venous anastomosis We performed an angiogram of the right subclavian vein. The right subclavian vein was 95% stenosed. multiple stenoses, flow seems to follow the catheter from the left IJ. essentially occluded.
We performed an angiogram of the superior vena cava. The superior vena cava was occluded
We catheterized the right innominate vein. Getting access to the IVC was difficult. Multiple catheter angles and gidewires used to try to cross the occlusion to the SVC without success.
We catheterized the left innominate vein and flow appears to go from left innominate bak to the heart.
We balloon dilated the right subclavian vein to 30 Atm for 1 min with a 8 mm by 80 mm Conquest 40 balloon from BD Interventional. Pre-treatment stenosis was 95% with plaque and thrombus. Post-treatment stenosis was 40% with thrombus. We performed an angiogram of the right brachiobasilic fistula. The right brachiobasilic fistula was __% stenosed with intimal hyperplasia. Compression of the venous anastomosis allowed runoff to the radial and ulnar arteries. We performed an angiogram of the right radial artery. The right radial artery was 70% stenosed with calcification. There is flow to radial as wellas ulnar arteries from the graft We then closed the puncture site on the right brachiobasilic fistula with suture.
SuperCoder Answered Wed 29th of April, 2020 08:52:23 AM