PREOPERATIVE DIAGNOSIS: Chronic renal failure.
POSTOPERATIVE DIAGNOSIS: Chronic renal failure.
PROCEDURE PERFORMED: Creation of left basilic vein transposition fistula.
SURGEON: John Doe, MD
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old Hispanic female who presented for second stage of basilic transposition in the left arm. The patient had first stage done previously. The basilic vein was transposed over the left biceps and anastomosed to the brachial artery.
DESCRIPTION OF PROCEDURE: An incision was made through the subcutaneous tissue along the side of the basilic vein. The basilic vein was pretty well mobilized and anastomosed to the brachial artery in the past. This anastomosis was found, and the vein was isolated by making a long incision up to axilla down to the fascia.
After all the dissection, the medial and lateral cutaneous nerve was seen and spared. Dissection was carried down below the fascia along the fistula exposing the vein up to the axilla. All the collaterals were clamped, ligated, transected, and doubly ligated with 2-0 silk. Large holes were oversewn with 5-0 Prolene. The nerve again was seen and was spared. The vein was marked with methylene blue.
The anastomosis was taken down and doubly ligated with 2-0 silk, transected, and oversewn with 5-0 Prolene. The vein was moved from the bed. Then, the vein was transposed in the upper arm by making three contralateral incisions. The vein was accessed with a red rubber tube, and tunnel was made with tunneling instrument, and the vein was brought very carefully preventing from twisting up to the brachial artery. The brachial artery was exposed making an incision in the skin and subcutaneous tissues down to the fascia.
Proximal and distal control was obtained with angled DeBakey clamps, and arteriotomy was made. The vein was spatulated and anastomosed in an end-to-side fashion with two continuous 6-0 Prolene sutures for the posterior wall and interrupted 6-0 for anterior wall. Upon releasing the clamps, a palpable pulse was obtained. The tunnel incision was closed with 5-0 nylon. The large median incision was closed, subcutaneous tissue with 3-0 PDS and subcuticular Monocryl. Steri-Strips were applied. The patient left the OR in good condition with a palpable thrill.
