Ask Dr. Z

Please do NOT include any actual patient medical records with your question. The patient is a 54-year-old woman with a history of end-stage renal disease who is status post creation of a left forearm arteriovenous fistula at an outside hospital. SURGICAL PROCEDURE IN DETAIL: the left upper extremity was prepped and draped in standard surgical fashion. A forearm arteriovenous fistula was present. This fistula was cannulated using a micropuncture set and a fistulogram was obtained. The study revealed an antecubital arteriovenous fistula with outflow to both the cephalic and basilic veins. The central veins were unremarkable. The decision was made to proceed with a left brachiocephalic arteriovenous fistula. Through a transverse incision above the elbow, the cephalic vein was circumferentially dissected and transposed onto the brachial artery. An end-to-side anastomosis was performed using a running 7-0 Prolene suture. The proximal anastomosis of the antecubital vein arteriovenous fistula was dissected through the same incision. This fistula was ligated and divided between clamps and oversewn with Prolene suture. My question is - is this a revision since patient has forearm fistula a new fistual from basillic to brachial, if it is new fistula how do we capture the fistulogram and ligation of old one? Thanks