CPT® Code 35188

1. Indications

The procedure for repairing an acquired or traumatic arteriovenous fistula in the head and neck is indicated under the following circumstances:

• Trauma to Blood Vessels The presence of an arteriovenous fistula resulting from an injury or trauma to the blood vessels in the head and neck region.
• Symptoms of High-Pressure Blood Flow Symptoms that may arise due to the abnormal communication, such as swelling, pain, or other cardiovascular complications associated with increased venous pressure.

2. Procedure

The surgical procedure for the repair of an acquired or traumatic arteriovenous fistula involves several critical steps to ensure effective treatment and restoration of normal blood flow.

• Step 1: Angiography Initially, a separately reportable angiography is performed to accurately delineate the course of the arteriovenous fistula. This imaging technique helps the physician visualize the anatomy and plan the surgical approach.
• Step 2: Exposure and Dissection The physician then makes an incision to expose the fistula. Careful dissection is performed to free the fistula from the surrounding tissues, ensuring that the surgical field is clear for the subsequent steps.
• Step 3: Isolation of the Fistula Clamps are placed on both the artery and the vein to isolate the fistula. This step is crucial as it prevents blood flow during the repair process, allowing for a safer and more controlled environment for the surgery.
• Step 4: Severing the Fistulous Communication The abnormal connection between the artery and vein is then severed. This step is essential to eliminate the high-pressure flow from the artery into the vein.
• Step 5: Repair of the Vessels Following the severing of the fistula, the artery and vein are repaired. This can be accomplished using sutures to close the vessels or, alternatively, a synthetic patch or vein graft may be utilized to ensure proper healing and restoration of blood flow.
• Step 6: Hemostasis and Closure After the repair, the clamps are removed, and hemostasis is checked to ensure there is no bleeding at the repair site. Finally, the overlying tissues are closed in layers to complete the surgical procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as bleeding or infection at the surgical site. Patients may require follow-up visits to assess the success of the repair and ensure that normal blood flow has been restored. Additionally, any symptoms related to the previous arteriovenous fistula should be evaluated to confirm that they have resolved following the surgical intervention.