Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)
CPT4 code
Name of the Procedure:
Revision, Open, Arteriovenous Fistula
Common Names: AV Fistula Revision, Dialysis Graft Revision
Summary
A surgical procedure performed to repair or correct an existing arteriovenous (AV) fistula used for dialysis. This involves making changes to the fistula without removing any blood clots (thrombectomy) and can involve either autogenous (using the patient's tissue) or nonautogenous (using synthetic materials) grafts.
Purpose
Addresses: Dysfunctional or poorly performing AV fistula used for hemodialysis. Goals: Improve blood flow through the fistula, extend its usable life for dialysis, and alleviate symptoms such as swelling, pain, or ineffective dialysis.
Indications
Symptoms/Conditions:
- Poor blood flow through the AV fistula
- Swelling or infection at the fistula site
- Inadequate dialysis performance
- Pain or discomfort around the fistula Patient Criteria:
- Patients experiencing issues with their current AV fistula
- Individuals who require long-term dialysis access
Preparation
Instructions for Patient:
- Fasting for at least 8 hours before surgery
- Stopping certain medications (e.g., blood thinners) as advised Diagnostic Tests:
- Preoperative blood tests
- Ultrasound or angiography to assess the fistula
Procedure Description
- Patient is administered local or general anesthesia.
- An incision is made near the existing AV fistula.
- Surgeon identifies and corrects the problematic area of the fistula.
- Adjustments are made either to the arterial or venous segments as needed.
- The incision is closed with sutures. Tools: Scalpel, retractors, sutures, surgical clamps. Anesthesia: Local or general anesthesia based on the patient's condition and surgeon's preference.
Duration
Typically lasts between 1 to 2 hours.
Setting
Performed in a hospital's operating room or a specialized outpatient surgical center.
Personnel
Involved Healthcare Professionals:
- Vascular surgeon
- Operating room nurses
- Anesthesiologist or nurse anesthetist (if general anesthesia is used)
Risks and Complications
Common Risks:
- Infection at the incision site
- Bleeding or hematoma Rare Risks:
- Nerve injury
- Rejection of nonautogenous graft materials Complications Management: Usually managed with medications, wound care, and close monitoring.
Benefits
Expected Benefits:
- Improved blood flow through the fistula
- Enhanced effectiveness of dialysis
- Reduced risk of further complications
Recovery
Post-Procedure Care:
- Keep the surgical site clean and dry
- Follow prescribed medication regimen
- Regular follow-up appointments for monitoring Recovery Time: Generally takes about 1 to 2 weeks for initial recovery, full recovery in about 6 weeks. Restrictions: Limited physical activity to prevent strain on the fistula site; avoid lifting heavy objects.
Alternatives
Other Treatment Options:
- Percutaneous transluminal angioplasty (PTA)
- Creation of a new AV fistula Pros and Cons: PTA is less invasive but might be less effective for severe cases; a new AV fistula creation might be necessary if revision is unsuccessful but involves a longer recovery period.
Patient Experience
During the Procedure:
- Patients under general anesthesia will be asleep; those with local anesthesia may feel minimal discomfort. After the Procedure:
- Mild to moderate pain around the incision site managed with pain medication
- Instructions for activity restrictions and wound care.