PREOPERATIVE DIAGNOSIS
Hypertensive stage 5 chronic kidney disease and need of dialysis access.

POSTOPERATIVE DIAGNOSIS
Same.

PRIMARY PROCEDURE
PLACEMENT OF ARTERIOVENOUS FISTULA, CIMINO-TYPE PROCEDURE.

PROCEDURE
After informed consent, the patient was brought to the operating room and placed supine on the table. After induction of anesthesia, the patient was prepped and draped appropriately. The cephalic vein and radial artery were identified and marked. An area was marked between these 2, and the area was infiltrated with Marcain and epinephrine prior to making the incision. The cephalic vein was dissected out first followed by the radial artery. The distal end of the vein was clamped and transected. The radial artery and both ends were occluded. Bleeding was controlled appropriately with clamps. An end-to-end anastomosis was performed with GoreTex sutures. Prior to completing the anastomosis, the fistula was flushed with heparinized saline. The procedure was completed with the final sutures. Evaluation of the flow in the vessel resulted in good thrill and bruit present throughout the entire area. The subcutaneous tissue and skin were closed appropriately, and sterile dressings were applied. The fistula will be evaluated in the next 24 hours for dialysis use.
ICD-10-CM:
ICD-10-CM: