Arteriovenous anastomosis, open; by upper arm cephalic vein transposition
CPT4 code
Name of the Procedure:
Arteriovenous Anastomosis, Open; by Upper Arm Cephalic Vein Transposition
Summary
In layman's terms, this procedure involves connecting an artery to a vein in the upper arm through surgery, specifically moving the cephalic vein to make the connection. This helps improve blood flow and is often done as part of preparing for dialysis.
Purpose
This procedure addresses conditions requiring enhanced blood flow access, such as for dialysis in patients with kidney failure. The goal is to create a reliable site for dialysis where blood can be efficiently filtered and cleaned by the dialysis machine.
Indications
- Chronic kidney disease requiring dialysis
- Poor existing vascular access for dialysis
- Difficulty in achieving efficient dialysis through other means due to weak or scarred veins
Preparation
- Patients are usually instructed to fast for a specific period before surgery.
- Medication adjustments may be necessary, especially for blood thinners or anticoagulants.
- Pre-procedure assessments typically include blood tests, imaging studies like Doppler ultrasound, and physical examination of the veins and arteries.
Procedure Description
- The patient is typically given general anesthesia or a local anesthetic with sedation.
- The surgeon makes an incision in the upper arm to expose the cephalic vein and a nearby artery.
- The cephalic vein is carefully dissected and moved (transposed) to a new position close to the artery.
- The vein is then sutured to the artery, creating a direct connection where arterial blood can flow into the vein.
- The incision is closed with surgical stitches, and bandages are applied.
This procedure uses specialized surgical tools, including clamps, sutures, and possibly microscopes for precision.
Duration
The procedure generally takes between 2 to 4 hours, depending on the complexity and patient-specific factors.
Setting
The procedure is performed in a hospital surgical suite or an outpatient surgical center.
Personnel
- Vascular surgeon or transplant surgeon
- Operating room nurses
- Anesthesiologist
- Surgical technician
Risks and Complications
Common risks include:
- Infection at the incision site
- Bleeding or blood clots
- Swelling or bruising in the arm
Rare complications can include:
- Nerve damage
- Failure of the anastomosis resulting in poor or no blood flow
- Aneurysm formation at the surgical site
Benefits
The expected benefits include a reliable vascular access site for dialysis with improved blood flow. The benefits can typically be realized within a few weeks as the anastomosis matures and strengthens.
Recovery
- Patients are advised to avoid heavy lifting and strenuous activities with the arm for several weeks.
- Pain management includes prescribed medications and over-the-counter pain relievers.
- Follow-up appointments are necessary to monitor the maturation of the arteriovenous fistula and to check for any signs of complications.
- Specific care instructions include keeping the incision site clean and dry, and observing for signs of infection.
Alternatives
- Hemodialysis catheters (temporary and typically less desirable due to higher infection risks)
- Peritoneal dialysis
- Other types of vascular access surgery, such as using a different vein or creating a graft
Each alternative has its pros and cons which should be discussed in detail with the healthcare provider.
Patient Experience
During the procedure, the patient will be under anesthesia and should not feel pain. Post-procedure, mild to moderate discomfort in the arm is common, managed by pain medication. Swelling and bruising are expected initially but should decrease with time. Patients might experience tingling or numbness sometimes due to nerve irritation, usually resolving in the weeks following the procedure.
Pain management and comfort measures will be a key part of post-surgical care, with regular monitoring to ensure proper healing and functionality of the new vascular access.