[Expert Solution]: Documentation Dissection PREOPERATIVE…

Documentation Dissection PREOPERATIVE DIAGNOSIS: Stage IV chronic kidney disease. POSTOPERATIVE DIAGNOSIS: Stage IV chronic kidney disease. PROCEDURE: Creation of right upper arm anastomosis by transposition with intraoperative ultrasound. ANESTHESIA: General. INDICATIONS: The patient is a 60 -year-old lady who is expected to require hemodialysis in the near future. She presents for elective creation of an anastomosis. DESCRIPTION: Under adequate general anesthetic, the arm was prepped and draped in the usual sterile fashion. Ultrasound was used to map the area of the vein. The upper arm cephalic vein again appeared to be the most appropriate. An incision was made in the antecubital fossa over the median cubital vein leading up to the cephalic. Electrocautery and blunt dissection was used to mobilize up the median cubital. An area of branching was ligated distally and divided, creating a Carrel patch. Several of the side branches were clipped with hemoclips. The vein was mobilized proximally and flushed with heparinized saline. A 4.5 mm dilator easily passed without restriction. The brachial artery was then mobilized up medially with sharp dissection and isolated with a vessel loop. Five thousand units of intravenous heparin were given and circulation time allowed to elapse. An arteriotomy was then performed after control obtained with vascular clamps. An end to side anastomosis was then performed with a running 6.0 Prolene. Clamps were back bled and released. Excellent hemostasis was observed. An appropriate thrill was palpable in the proximal aspect of the fistula. Ultrasound was again used to map 2 other areas of branching. These were each controlled with a small stab incision and sutured ligation. Ultrasound was again used to evaluate the fistula. There was appropriate Doppler flow and no evidence of further side branching. Wounds were then closed with deep 4-0 PDS and interrupted 4-0 nyon. Sterile dressings were applied. The patient tolerated the procedure well. What are the CPT