Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); nonautogenous graft (eg, biological collagen, thermoplastic graft)
CPT4 code
Name of the Procedure:
Creation of Arteriovenous Fistula by Other Than Direct Arteriovenous Anastomosis; Nonautogenous Graft (e.g., Biological Collagen, Thermoplastic Graft)
Summary
This procedure involves creating a connection between an artery and a vein using a graft made from nonautogenous materials like biological collagen or thermoplastic. This helps in better blood flow for patients requiring long-term hemodialysis.
Purpose
This procedure is commonly performed for patients with end-stage renal disease who need hemodialysis. The goal is to create a reliable and durable vascular access point that allows for efficient blood flow during dialysis sessions.
Indications
- Chronic kidney disease requiring hemodialysis
- Poor vascular condition unsuitable for direct arteriovenous anastomosis
- Previous failure of direct AV fistulas
Preparation
- Fasting for at least 6-8 hours prior to the procedure
- Discontinuation or adjustment of certain medications as advised by the doctor
- Diagnostic imaging tests to map the vascular anatomy
Procedure Description
- The patient is given local or general anesthesia.
- An incision is made near the chosen site.
- A synthetic graft is inserted to connect an artery to a vein.
- The graft is carefully sutured to ensure proper blood flow.
- The incision is closed and bandaged.
Tools and technology used include surgical instruments, graft materials like biological collagen or thermoplastic, and possibly ultrasound for precise placement.
Duration
The procedure typically takes between 1 to 2 hours.
Setting
This procedure is performed in a hospital surgical suite or an outpatient surgical center.
Personnel
- Vascular surgeons
- Surgical nurses
- Anesthesiologists
- Technicians
Risks and Complications
- Infection at the graft site
- Blood clot formation
- Graft failure or rejection
- Bleeding or hematoma
- Nerve injury
Benefits
The main benefit is the establishment of a reliable vascular access point for hemodialysis, leading to improved dialysis efficiency and patient outcomes. The benefits are generally noticed almost immediately after the healing of the surgical site.
Recovery
- The patient may be observed for a few hours before discharge.
- Pain management with prescribed medications.
- Keep the surgical site clean and dry.
- Follow-up appointments to monitor graft function and healing.
- Avoid heavy lifting or strenuous activities for a few weeks.
Alternatives
- Direct arteriovenous fistula without a graft
- Central venous catheter placement
- Peritoneal dialysis
Each alternative has its own set of advantages and disadvantages regarding complexity, risks, and durability compared to the described procedure.
Patient Experience
During the procedure, the patient will be under anesthesia and should not feel any pain. Post-procedure, some discomfort and pain at the incision site are common but manageable with medications. There might be some swelling or bruising initially. Regular follow-up is crucial to ensure the graft is functioning well.