36831 Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft (separate procedure)

Name of the Procedure:

Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft (separate procedure)

Summary

An open thrombectomy is a surgical procedure to remove a blood clot (thrombus) from an arteriovenous fistula or dialysis graft. This is done without altering the structure of the fistula or graft itself.

Purpose

The procedure addresses the blockage caused by a blood clot in an arteriovenous fistula or dialysis graft, which is essential for patients undergoing hemodialysis. The goal is to restore proper blood flow through the fistula or graft, ensuring effective dialysis treatment.

Indications

• Symptoms: Swelling, pain, or a noticeable drop in the efficiency of dialysis.
• Conditions: Identified blood clot in an arteriovenous fistula or dialysis graft.
• Patient Criteria: Individuals with compromised dialysis access due to thrombosis.

Preparation

• Pre-Procedure Instructions: Patients may need to fast for a specific period prior to the procedure. Medication adjustments, especially blood thinners, might be necessary.
• Diagnostic Tests: Ultrasound or angiogram may be performed to locate the clot and plan the procedure.

Procedure Description

1. Anesthesia: Local or general anesthesia is administered based on the patient's condition and the surgeon’s preference.
2. Incision: A small incision is made over the site of the fistula or graft.
3. Clot Removal: Specialized instruments are used to extract the clot from the blood vessel.
4. Closure: The incision is then closed with sutures.

Tools and Equipment:

• Scalpel
• Vascular clamps
• Suction devices
• Catheters

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

This procedure is generally performed in a hospital operating room or a surgical center equipped for vascular surgeries.

Personnel

• Surgeon: Performs the procedure.
• Nurses: Assist during surgery and provide post-operative care.
• Anesthesiologist: Manages anesthesia.

Risks and Complications

• Common Risks: Infection, bleeding, and recurrence of the clot.
• Rare Risks: Damage to the blood vessel, allergic reactions to anesthesia, and complications from blood thinners.

Benefits

The primary benefit is the restoration of proper blood flow through the fistula or graft, ensuring effective hemodialysis. Patients typically notice an improvement in symptoms immediately after the procedure.

Recovery

• Post-Procedure Care: Patients may need to remain in the hospital for observation. Instructions may include wound care, activity restrictions, and follow-up appointments.
• Recovery Time: Patients can usually return to regular activities within a few days to a week but should avoid strenuous activities for a longer period.

Alternatives

• Other Options: Angioplasty, stenting, or percutaneous thrombectomy.
• Pros and Cons: Non-surgical options may have shorter recovery times but might be less effective in certain cases.

Patient Experience

Patients might experience some discomfort and pain post-procedure, managed with prescribed pain medications. The incision site may be tender and require careful handling to avoid infection. Regular follow-ups are crucial to monitor the fistula or graft.

This markdown text provides a comprehensive overview of the open thrombectomy procedure for an arteriovenous fistula or dialysis graft without revision.