Ask Dr. Z

"Open thrombectomy of AV fistula. Thrombus was extracted, but no good back bleeding. Fogarty passed at shoulder level but could not be passed into the central circulation. Performed fistulogram. Shows occlusion of cephalic vein before it entered the subclavian. Brought up a catheter & could get through the obstruction to the superior vena cava. Passed catheter beyond that, pulled the wire & performed imaging which confirmed patency of the proximal left brachiocephalic vein and the superior vena cava. Angioplastied along the length of the area that appeared abnormally narrowed, several inflations were performed, followup imaging revealed recanalization of the cephalic vein arch, resolution of the stenosis, good flow through the left brachiocephalic vein & the superior vena cava. There was now reflux into axillary vein distal to the cephalic arch." 36831 open, 36902-XU cephalic-peripheral. Do you feel the brachiocephalic was also angioplastied? (Procedure header states angioplasty of the left cephalic vein arch and of the left brachiocephalic vein)