Name of the Procedure:

Creation of Arteriovenous Fistula, Percutaneous (C9754) Common names: Percutaneous AV Fistula Creation, Endovascular Arteriovenous Fistula Technical terms: Arteriovenous Fistula, Endovascular Fistula Creation

Summary

In simple terms, this procedure involves creating a connection between an artery and a vein using a minimally invasive method to allow for better blood flow, typically for dialysis access. It includes using imaging tools to guide the process and may involve additional techniques to ensure proper blood flow.

Purpose

This procedure is primarily used to facilitate hemodialysis for patients with chronic kidney disease. The goal is to create a reliable, durable access point for dialysis by connecting an artery to a vein, allowing for efficient blood flow and dialysis treatment.

Indications

This procedure is indicated for:

• Patients with chronic kidney disease who require hemodialysis.
• Individuals with poor existing dialysis access sites.
• Patients needing an alternative to surgical creation of an AV fistula due to medical concerns.

Preparation

• Patients may be advised to fast for a certain period before the procedure.
• Blood tests and imaging studies, such as Doppler ultrasound, are typically done to assess vein and artery conditions.
• Patients should inform their doctors about medications they are taking and might need to adjust them accordingly.

Procedure Description

1. Initial Access: The doctor numbs the area with local anesthesia and inserts a needle into a suitable vein and artery.
2. Guide Wire Insertion: A guide wire is threaded through the needle into the blood vessels.
3. Balloon Angioplasty: A balloon catheter might be used to widen the vein or artery.
4. Creation of Connection: Using imaging guidance, the artery and vein are connected with specialized tools.
5. Secondary Procedures: Techniques like coil embolization or further angioplasty might be employed to ensure proper blood flow.
6. Imaging Confirmation: The use of fluoroscopy or ultrasound confirms the fistula creation's success.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is usually performed in a hospital’s interventional radiology suite or an outpatient surgical center equipped with advanced imaging technology.

Personnel

• Interventional Radiologist or Vascular Surgeon
• Nurses
• Radiologic Technologist
• Anesthesiologist or Nurse Anesthetist (for sedation purposes)

Risks and Complications

• Infection at the access site
• Bleeding or hematoma
• Thrombosis (blood clot formation)
• Vessel damage
• Failure to create a functional fistula
• Rare complications like nerve damage or severe allergic reactions

Benefits

• Provides a reliable access point for hemodialysis
• Minimally invasive with faster recovery time compared to surgical methods
• Reduced hospital stay and quicker return to normal activities

Recovery

• The patient will need to rest and keep the access site clean and dry.
• Pain and swelling at the site are manageable with medications.
• Most patients can resume normal activities within a few days, but strenuous activities should be avoided.
• Follow-up appointments will be scheduled to monitor the fistula's functionality.

Alternatives

• Surgical creation of AV fistula
• AV graft placement
• Central venous catheter for temporary dialysis access
• Peritoneal dialysis
• Pros of alternatives: Surgical AV fistula might be more durable; AV graft is usable sooner.
• Cons of alternatives: Surgical methods are more invasive; central venous catheters have higher infection risks.

Patient Experience

• Patients might feel mild discomfort or pain during the local anesthesia injection.
• Sedation may cause drowsiness but minimize discomfort during the procedure.
• Post-procedure, there might be some soreness or bruising at the access site.
• Any pain or discomfort is usually manageable with prescribed analgesics.