Preoperative Diagnosis: Pseudoaneurysm of radial artery and pseudoaneurysm of AV fistula, right upper extremity.
Anesthesia: Local with IV sedation block.
Estimated Blood Loss: 100 cc.
Operative Procedure: The patient was identified and escorted to the operating room. The patient was placed in supine position, and IV sedation and preoperatively supraclavicular right upper extremity block was given under ultrasound guidance by the anesthesiologist. The patient was taken to the operating room. The right upper extremity was prepped and draped in the usual fashion. Tourniquet was placed in the upper extremity to a pressure of 250 mmHg. Incision was made over the pseudoaneurysm starting at the radial artery. Skin surface and deep fascia were divided. The radial artery was dissected. The pseudoaneurysm was dissected. The pseudoaneurysm was excised. The radial artery was closed with primary closure of 5-0 Prolene. Next, an elliptical incision involving the large 5 x 5 cm pseudoaneurysm was made measuring 3 cm in its width and about 10 cm in length. Skin surface and deep fascia were divided. The whole aneurysm was excised including the fistula. Another incision was made higher up in the forearm and the pseudoaneurysm and the fistula was excised there. All the branches were ligated with 2-0 silk. The distal fistula near the antecubital crease was ligated with 2-0 silk. Advancement flaps of the large defect in the forearm were carried out. The closure was carried out with two layers using 3-0 Vicryl and nylon for the skin. Compressive bandages applied to the right upper extremity. The tourniquet was taken down after all vascular control and ligation was carried out. The tourniquet time was 18 minutes.
The patient was transferred to the recovery room in stable condition for postoperative care and management.