CPT® Code 36818

An open arteriovenous anastomosis is a surgical procedure designed to create a direct connection between an artery and a vein, facilitating hemodialysis access for patients with renal failure. This specific procedure, identified by CPT® Code 36818, involves the transposition of the upper arm cephalic vein. The primary goal of this intervention is to establish a reliable vascular access point that can withstand the repeated needle insertions required for hemodialysis treatments. The procedure begins with the surgeon making incisions in the upper arm to access both the brachial artery and the cephalic vein. The cephalic vein is carefully evaluated to ensure it is patent (open) and of sufficient size to accommodate the demands of hemodialysis. Following this assessment, a subcutaneous tunnel is created to facilitate the movement of the vein to a more superficial position, allowing for easier access. The cephalic vein is then mobilized, and any branches are ligated to prepare it for transection. The vein is cut to an appropriate length, pulled through the tunnel, and then sutured to the brachial artery, completing the anastomosis. This procedure is critical for patients requiring regular hemodialysis, as it provides a durable and accessible site for vascular access.