Ask Dr. Z

Is the procedure reported open or percutaneous? "A micropuncture needle was used to access the AVF close to the arterial anastomosis. A microcath/dilator was inserted. Venogram: high grade 80% stenosis at the level of a subclavian SVC stent; multiple in stent stenoses at the axillary v. A glide wire was passed into the atrium using a kmp catheter, replaced with a super stiff wire, upsized to a 6 introducer. At one point we could not pass the balloon cath centrally because of resistance to pushing it in so a more proximal cannulation was done with a micropuncture needle, which was up sized to a 6 introducer, and a 6, 8, and 10 mm diameter 4 cm long charger balloon dilatation cath were used to dilate the lesion to profile. The 100 balloon burst on a calcific plaque and got hung up pulling it out, so xylocaine was infiltrate, the fistula was dissected out to control it proximally and distally, and the balloon cath was removed. The opening was closed with 5-0 prolene. The wound was closed with vicryl and Monocryl and a single nylon for hemostasis. The cath was removed after a 3-0 nylon suture and swizzle stick was place."