CPT® Code 36830

Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); nonautogenous graft (eg, biological collagen, thermoplastic graft)

The procedure described by CPT® Code 36830 involves the creation of an arteriovenous (AV) fistula using a method that is not a direct arteriovenous anastomosis. An AV fistula is a surgically created connection between an artery and a vein, primarily intended to facilitate long-term access to the vascular system for patients undergoing hemodialysis. This connection is crucial for patients with kidney failure, as it allows for repeated access to the bloodstream for the purpose of dialysis treatment. The procedure typically begins with an incision made in the forearm at the site where the AV fistula will be established. During the surgery, both the artery and vein are carefully selected, exposed, and dissected from surrounding tissues to ensure proper placement of the graft. In cases where a nonautogenous graft is utilized, materials such as biological collagen or thermoplastic grafts are employed instead of using the patient's own vein. This is particularly beneficial in patients who may not have suitable veins for grafting. The surgical technique involves placing vessel loops around the selected artery and vein to control blood flow during the procedure. The graft is then sutured to both the artery and the vein, allowing for increased blood flow into the vein, which subsequently enlarges and thickens over time. This adaptation of the vein is essential for withstanding the repeated punctures required for hemodialysis access. It is important to note that CPT® Code 36830 is specifically designated for procedures involving nonautogenous grafts, while CPT® Code 36825 should be used when an autogenous graft is employed.