Arteriovenous anastomosis, open; by forearm vein transposition
CPT4 code
Name of the Procedure:
Arteriovenous Anastomosis, Open; By Forearm Vein Transposition
Summary
This surgical procedure involves creating a connection between an artery and a vein in the forearm. The vein is repositioned or "transposed" to improve blood flow, usually to facilitate dialysis access.
Purpose
The procedure addresses poor vascular access in patients who need long-term dialysis due to kidney failure. The goal is to create a durable and reliable access point for dialysis.
Indications
- Chronic kidney disease requiring hemodialysis.
- Poor vascular access from previous attempts.
- Suitable vein and artery identified by preoperative assessment.
Preparation
- Fasting for 8-12 hours prior.
- Adjustment of certain medications as directed by the physician.
- Preoperative imaging studies like ultrasound or venography to map veins and arteries.
Procedure Description
- The patient is placed under local or regional anesthesia.
- An incision is made in the forearm to expose the selected vein.
- The vein is detached from its original location and transposed to an adjacent artery.
- A connection (anastomosis) is created between the artery and the vein.
- The incision is closed with sutures or staples.
Tools and equipment include surgical scalpel, sutures, vascular clamps, and an operating microscope for precision.
Duration
The procedure typically takes 2 to 4 hours.
Setting
The surgery is performed in a hospital's operating room or a specialized outpatient surgical center.
Personnel
- Vascular Surgeon
- Surgical Nurses
- Anesthesiologist or Nurse Anesthetist
Risks and Complications
Common risks:
- Infection
- Bleeding
- Swelling
Rare risks:
- Thrombosis (clot formation)
- Steal syndrome (reduced blood flow)
- Nerve injury
Benefits
- Improved dialysis efficiency
- Long-term vascular access
- Reduced need for temporary dialysis catheters
Benefits are typically realized within a few weeks to a month post-surgery.
Recovery
- Immediate post-procedure observation for a few hours.
- Discharge either the same day or after an overnight stay.
- Keeping the arm elevated and avoiding heavy lifting for a few weeks.
- Follow-up appointments to monitor the function of the access site.
Alternatives
- Percutaneous dialysis catheters: temporary and higher infection risk.
- Arteriovenous graft: synthetic material used, associated with higher complications.
- Peritoneal dialysis: alternative modality, less efficient for some patients.
Patient Experience
During the procedure, the patient will not feel pain due to anesthesia. Afterward, there may be some discomfort and swelling, managed with pain medication. Full recovery usually takes a few weeks, with activity restrictions gradually lifted.