Angiography, arteriovenous shunt (eg, dialysis patient fistula/graft), complete evaluation of dialysis access, including fluoroscopy, image documentation and report (includes injections of contrast and all necessary imaging from the arterial anastomosis a
CPT4 code
Name of the Procedure:
Angiography, Arteriovenous Shunt
Common Name: Dialysis Access Evaluation
Technical Term: Complete Evaluation of Dialysis Access using Angiography, including fluoroscopy, image documentation, and report.
Summary
An angiography of an arteriovenous shunt is a diagnostic procedure used to evaluate blood flow in a dialysis access fistula or graft. It involves injecting a contrast dye into the bloodstream and taking X-ray images to visualize the vascular system.
Purpose
This procedure addresses issues with dialysis access grafts or fistulas, such as blockages or narrowing. The goal is to ensure proper functioning of the access used for dialysis, which is crucial for patients with kidney failure.
Indications
- Decreased dialysis efficiency
- Swelling or discomfort around the access site
- Suspected blockage or narrowing of the graft or fistula
- Elevated venous pressures during dialysis
- Difficulty with needle placement or blood flow during dialysis sessions
Preparation
- Fasting 4-6 hours before the procedure
- Notify the healthcare provider of any allergies, especially to contrast dyes
- Blood tests to check kidney function and clotting factors
- Adjusting certain medications as advised by the healthcare provider
Procedure Description
- Patient Positioning: The patient lies on an X-ray table.
- Local Anesthesia: A local anesthetic is administered to numb the access site.
- Insertion: A catheter is inserted into the access point (fistula or graft).
- Contrast Injection: A contrast dye is injected through the catheter.
- Imaging: X-ray images are taken using fluoroscopy to visualize the blood vessels.
- Evaluation: The images are reviewed to identify any issues such as blockages or narrowing.
- Documentation: All images and findings are documented, and a report is generated.
Tools and Equipment
- X-ray machine with fluoroscopy capabilities
- Catheter
- Contrast dye
- Local anesthetic
Duration
Typically 30 minutes to 1 hour.
Setting
The procedure is performed in a hospital radiology department or an outpatient clinic equipped with fluoroscopy facilities.
Personnel
- Radiologist or Interventional Nephrologist
- Radiology Technologist
- Nurses
Risks and Complications
- Allergic reaction to contrast dye
- Infection at the catheter insertion site
- Vascular injury or bruising
- Blood clot formation
- Rarely, kidney damage from the contrast dye
Benefits
- Accurate assessment of dialysis access
- Identification and possible immediate treatment of problems
- Improved dialysis efficiency
- Early detection of potential access issues
Recovery
- Monitoring for allergic reactions or complications
- Keeping the insertion site clean and dry
- Avoiding heavy lifting or strenuous activity for 24-48 hours
- Follow-up appointments as recommended
Alternatives
- Doppler ultrasound: Non-invasive but less detailed
- Clinical assessment: Less precise, based on symptoms and physical exam
- MRI angiography: Non-invasive but not suitable for all patients due to MRI contraindications
Patient Experience
During the procedure, patients may feel pressure when the catheter is inserted and a warm sensation when the contrast dye is injected. Post-procedure, there might be mild discomfort at the insertion site, manageable with over-the-counter pain relievers. Regular activities can generally be resumed within a day, with specific instructions provided by the healthcare provider.