CPT® Code 36821

A direct arteriovenous anastomosis is a surgical procedure that creates a connection between an artery and a vein, allowing for increased blood flow to the vein. This is particularly important for patients requiring hemodialysis, as it provides a reliable access point for the dialysis process. The procedure is commonly known as a Cimino-type arteriovenous anastomosis or Cimino fistula, named after Dr. Belding H. Scribner, who developed this technique to improve dialysis access. The most frequently chosen site for this procedure is at the wrist, although other locations in the arm may also be utilized based on the patient's anatomy and clinical considerations. During the procedure, local anesthesia or a brachial plexus nerve block is typically administered to minimize discomfort. The surgical technique involves careful dissection and connection of the radial artery and the cephalic vein, ensuring that the anastomosis is performed in a manner that optimizes blood flow and minimizes complications. This procedure is classified as a separate procedure, indicating that it is distinct from other surgical interventions that may be performed concurrently.