DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Renal failure.
POSTOPERATIVE DIAGNOSIS: Renal failure.
PROCEDURE PERFORMED: Left upper arm basilic to brachial artery transposition, AV fistula.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Minimal.
CONDITION: Stable.
DESCRIPTION OF PROCEDURE: After an informed consent was obtained, the patient was taken to the OR and prepped and draped in a sterile fashion. Longitudinal incision was made in the medial aspect of the left upper arm. The brachial artery and basilic vein in this area was dissected from the surrounding tissue. Two separated longitudinal incisions were made in the upper arm to isolate and dissect the entire length of the basilic vein. Small and large branches of the basilic vein were ligated with 0 silk suture. A subcutaneous tunnel was then created laterally in a semicircular fashion connecting the most proximal and most distal incision.
At this point, the patient was given 5000 units of IV heparin. After adequate circulation time, the vein was then transected just below the antecubital crease. The vein was then brought out through the most proximal incision. The vein was then tunneled through, the subcutaneous tunnel created, and then we prepared for anastomosis.
An end-to-side anastomosis was created with the end of the now transposed basilic vein to the side of the brachial artery. The area was controlled proximally and distally with the vascular clamps. Arteriotomy was made and extended for approximately 10 mm. The anastomosis was completed with a running 6-0 Prolene suture.
Prior to completion of the anastomosis, the vein and artery all were flushed draining all debris and air bubble. The lumen was then filled with heparinized saline solution. The anastomosis was then completed. There was good hemostasis.
At the end of the procedure, a small amount of oozing was controlled with Surgicel. Each of the incisions were then injected with FloSeal. The incision was then reapproximated with 3-0 and 4-0 Vicryl. Steri-Strips and sterile dressing were applied. The patient was returned to the recovery room in stable condition.
