CPT® Code 36825

The procedure described by CPT® Code 36825 involves the creation of an arteriovenous (AV) fistula using a method that is not a direct arteriovenous anastomosis, specifically utilizing an autogenous graft. An AV fistula is a surgically created connection between an artery and a vein, which is essential for patients requiring long-term hemodialysis. This connection allows for repeated access to the vascular system, facilitating the efficient removal and return of blood during dialysis treatments. The procedure begins with an incision made in the forearm at the site where the AV fistula will be established. The surgeon carefully selects and exposes the artery and vein, ensuring they are free from surrounding tissues. To manage blood flow during the procedure, vessel loops are placed around both the artery and vein. If an autogenous graft is indicated, a segment of vein, typically harvested from the saphenous vein in the leg, is prepared. This involves making an incision over the saphenous vein, dissecting the soft tissue, and ligating any branches before removing the desired segment. The graft is then sutured to the artery and vein, allowing for increased blood flow to the vein, which will subsequently enlarge and thicken, making it suitable for repeated punctures necessary for dialysis access. This procedure is critical for patients with renal failure who depend on hemodialysis for their treatment.