Patient has a diagnosis of end-stage renal disease and requires creation of an arteriovenous fistula for hemodialysis. Pre-op imaging shows appropriate size and patency of the radial artery
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OP NOTE:
Patient has a diagnosis of end-stage renal disease and requires creation of an arteriovenous fistula for hemodialysis. Pre-op imaging shows appropriate size and patency of the radial artery and perforating vein suitable for percutaneous arteriovenous fistula creation in the upper extremity. Using ultrasound guidance, access is made of the target vein with a micropuncture needle. The needle is carefully navigated within the perforator vein and advanced to the level of the adjacent artery. The needle is exchanged for a sheath until the distal end enters the artery. A catheter is advanced into the artery. The catheter is removed and the balloon is dilated at the anastomosis to ensure adequate flow under ultrasound guidance. The balloon, guidewire, and sheath are removed. Hemostasis is obtained at the percutaneous venous access site using manual pressure.
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