Name of the Procedure:

Common Name: Percutaneous arteriovenous fistula (AVF) creation
Technical/Medical Term: Percutaneous arteriovenous fistula creation (AVF), direct, any site, by tissue approximation using thermal resistance energy, and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization) (HCPCS Code: G2170)

Summary

In simple terms, this procedure involves creating a direct connection between an artery and a vein using minimally invasive techniques and thermal resistance energy. This connection, known as an arteriovenous fistula, helps improve blood flow for patients who require treatments like hemodialysis.

Purpose

This procedure is primarily used to:

• Provide vascular access for hemodialysis in patients with kidney failure.
• Improve blood flow rates to facilitate more efficient dialysis treatment.
• Reduce the risk of complications compared to other types of vascular access, such as catheters or grafts.

Indications

• Chronic kidney disease or end-stage renal disease requiring hemodialysis.
• Inadequate blood flow or poor veins for traditional AVF techniques.
• Patients looking for a long-term and reliable vascular access solution.

Preparation

• Patients may need to fast for a certain period before the procedure.
• Medication adjustments, such as blood thinners, may be required.
• Pre-procedure assessments include blood tests, imaging studies, and a thorough evaluation of the patient’s vascular anatomy.

Procedure Description

1. Anesthesia: Local anesthesia is administered at the site of the fistula creation.
2. Access: A small incision is made to access the target artery and vein.
3. Tissue Approximation: Thermal resistance energy is used to create a connection between the artery and vein.
4. Blood Flow Direction: Secondary procedures like transluminal balloon angioplasty or coil embolization may be performed to optimize and redirect blood flow as necessary.
5. Closure: The incision is closed, and the area is bandaged.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

Usually performed in:

• Hospital operating rooms
• Outpatient surgical centers
• Specialized vascular access clinics

Personnel

• Vascular surgeons or interventional radiologists
• Nurses
• Anesthesiologists or nurse anesthetists, if necessary

Risks and Complications

Common Risks:

• Bleeding
• Infection at the incision site

Rare Risks:

• Blood clot formation
• Nerve damage
• Failure of the fistula to mature properly

Benefits

• Enhanced blood flow for hemodialysis
• Lower infection risk compared to catheters
• Longer lifespan and fewer complications compared to other vascular access methods
• Immediate function in some cases, though maturation may take a few weeks

Recovery

• Post-procedure, patients will need to monitor the site for signs of infection or complications.
• Patients can generally expect to return to normal activities within a few days, but they should avoid strenuous activities involving the arm where the fistula was created.
• Follow-up appointments are crucial to monitor the maturation and functionality of the fistula.

Alternatives

• Central Venous Catheter: Easier access but with higher infection rates and other complications.
• AV Graft: A synthetic tube connecting an artery and vein, posing higher risk of clots and infections compared to fistula.

Patient Experience

• During the Procedure: Minimal discomfort due to local anesthesia, though some pressure or movement sensations might be felt.
• After the Procedure: Mild soreness or bruising around the incision site; pain can usually be managed with over-the-counter pain relief. Regular follow-up ensures the fistula is functioning properly.