Arteriovenous anastomosis, open; by upper arm basilic vein transposition
CPT4 code
Name of the Procedure:
Arteriovenous anastomosis, open; by upper arm basilic vein transposition
Common Name(s): AV Fistula Creation, Basilic Vein Transposition
Summary
An arteriovenous anastomosis is a surgical procedure that involves connecting an artery to a vein to create a fistula. In the case of an upper arm basilic vein transposition, the basilic vein is moved and surgically joined to an artery to enhance dialysis access for patients with kidney failure.
Purpose
This procedure is primarily performed to provide reliable vascular access for hemodialysis in patients with end-stage renal disease (ESRD). The goal is to create a durable and functional connection that can withstand repeated needle insertions and deliver adequate blood flow.
Indications
- Chronic kidney disease or end-stage renal disease requiring hemodialysis
- Previous access sites (e.g., fistulas, grafts) that have failed
- Limited upper arm vein options for dialysis access
- Adequate blood vessels suitable for fistula creation
Preparation
- Fasting for at least 8 hours prior to the procedure
- Adjusting medications as advised by the doctor, particularly blood thinners
- Pre-operative blood tests and imaging studies (e.g., ultrasound, angiography) to map the veins and arteries
- Signing informed consent forms
Procedure Description
- Anesthesia: The patient is generally administered local anesthesia with sedation, or general anesthesia if required.
- Incision: A surgical incision is made in the upper arm to access the basilic vein.
- Dissection: The basilic vein is carefully dissected and freed from surrounding tissues.
- Mobilization: The surgeon transposes (moves) the vein from its deep location to a more superficial position.
- Anastomosis: The vein is then connected to a nearby artery, creating the fistula.
- Closure: The incision is closed with sutures, and the area is dressed.
Tools/Equipment: Surgical instruments, sutures, ultrasound machine, vascular clamps.
Duration
The procedure typically takes between 1 to 2 hours.
Setting
The procedure is usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Vascular Surgeon
- Anesthesiologist
- Surgical Nurses
- Operating Room Technicians
Risks and Complications
Common Risks:
- Infection at the surgical site
- Bleeding or hematoma formation
- Blood clotting in the fistula Rare Risks:
- Narrowing or blockage of the fistula over time
- Poor wound healing
- Failure of the fistula to mature (provide adequate dialysis access)
Benefits
- Provides a long-term, durable option for hemodialysis access
- Lower risk of infection compared to central venous catheters
- Improved quality of life and dialysis efficacy
Recovery
- Keep the surgical site clean and dry
- Avoid heavy lifting and strenuous activities for at least 2-3 weeks
- Follow-up with the surgeon to monitor fistula maturation
- Regular ultrasound evaluations to assess blood flow in the fistula
Alternatives
- Central venous catheter: Quicker but higher infection risk and shorter-term solution
- Synthetic graft: Faster maturation but may have a higher risk of complications compared to a native fistula
Patient Experience
During the procedure, patients typically do not feel pain due to anesthesia. Post-procedure, they may experience discomfort, swelling, and bruising at the surgical site. Pain management includes prescribed analgesics. Maturation of the fistula, ready for dialysis, typically takes 6-12 weeks.