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Q. is this a revision or a creation? My doc says a revision I think a new fistula. PROCEDURE IN DETAIL: The patient was taken to the Operating Room and placed in the supine position. Following smooth induction of general anesthesia, the left arm, hand and upper arm were prepped with Chloraprep solution and draped with sterile linens. The incision at the elbow was opened, and a small amount of serosanguineous fluid was evacuated. The vein was identified, and there was no intraluminal clot and there was no pulse when it was totally occluded. The vein was clamped and divided just at the level of the previous vein anastomosis, and there was good backbleeding. The vein was flushed with heparinized saline and clamped. The deep artery was located at the base of the incision and mobilized for about 2 cm. The patient was given 3,000 units of Heparin intravenously. The artery was clamped and opened obliquely. An end-to-side anastomosis was fashioned with interrupted #6-0 Prolene and medium AnastoClip staples. The clamps were released, and there was an excellent thrill and minimal pulse. There was a palpable pulse at the wrist. The incision was closed with #3-0 Vicryl and steri-strips after the stump of the vein had been oversewn with #6-0 Prolene. The patient tolerated the procedure well.