Pre-op Diagnosis: End stage renal disease (CMS/HCC) [N18.6]
Post-op Diagnosis: Same as Pre-op
Procedure(s): Left – LEFT AV FISTULA CREATION (CEPHALIC ADEQUATE) – Wound Class: Clean
Proc. Description(s) & CPT Code(s): LEFT AV FISTULA CREATION (CEPHALIC ADEQUATE):
Anesthesia: General
Complications: There were no complications
Findings: There is a thrill in the graft and a thrill in the vein distal to the graft. There is a biphasic radial artery and ulnar artery signal at the wrist
Technique: The consents were obtained. The patient was taken to the operating room and placed supine on operating table. General endotracheal anesthesia was administered. The left arm was extended, prepped, and draped in the usual manner using ChloraPrep. The procedure began with an incision over the palpable fistula at the elbow. Soft tissues were divided down to the fistula and the fistula was dissected proximally and distally and encircled with vessel loops. A separate incision was made just distal to the axilla in a longitudinal manner over the brachial vein. Soft tissues were divided down to the brachial vein and it was dissected proximally and distally and encircled with vessel loops. Next a 6 mm PTFE graft was tunneled in a subcutaneous manner and out each incision. A sterile tourniquet was placed over the arm at the biceps. 3000 units of heparin were given and 3 minutes were allowed to elapse. The arm was exsanguinated and the tourniquet was inflated to 250 mmHg. A 11. Blade was used to make an anterior arteriotomy in the proximal aspect of the indwelling fistula. Using 6 0 Prolene on a BV 1 needle an end-to-side anastomosis was performed between the graft and the indwelling fistula. At the completion of the anastomosis flow was allowed through the graft the graft was aspirated flushed and clamped. Proximal and distal control were then gained on the brachial vein. A 11. Blade was used to make an anterior venotomy. Using 5 0 Prolene on a C1 needle an end-to-side anastomosis was performed between the graft and the vein. At the completion of the anastomosis flow was allowed through the graft and through the vein. There is a thrill in the graft. There is a thrill in the vein distal to the anastomosis. The wounds were thoroughly irrigated with normal saline in hemostasis was obtained. The wounds were then closed in 3 layers of 2-0 Vicryl for the deep tissue layer 3-0 Vicryl for the dermal layer and staples for the skin. Sterile dressings were placed. The patient had biphasic signals in the radial artery and ulnar artery at the wrist. There were no complications procedure. The patient was awakened from anesthesia stable condition taken to the recovery
Disposition: awakened from anesthesia, extubated and taken to the recovery room in a stable condition, having suffered no apparent untoward event.
CPT code : 36830 Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); nonautogenous graft (eg, biological collagen, thermoplastic graft)
ICD-10: N18.6 ESRD
