CPT® Code 36832

An open revision of an arteriovenous (AV) fistula is a surgical procedure aimed at correcting complications that may arise from the initial creation of the fistula, which is typically used for dialysis access. This procedure is necessary when issues such as stenosis (narrowing of the blood vessel), thrombus formation (blood clot), or occlusion (blockage) occur in the AV fistula, particularly when it has been constructed using a graft. The surgical intervention involves making an incision in the skin and soft tissue over the affected area, allowing the surgeon to access the graft, artery, and vein directly. During the procedure, the blood vessels and graft are carefully dissected from the surrounding tissue to expose the problematic segment. To manage blood flow during the operation, vessel loops are placed both upstream and downstream of the stenosed area. If a thrombus is identified, it is removed through direct exposure, and techniques such as arterial back pressure or massage may be employed to facilitate the removal of the clot. The revision process may include the placement of a vein patch or the excision of the stenosed segment, followed by the attachment of a new segment of either autogenous vein or nonautogenous graft material. The use of a patch graft, often derived from the saphenous vein, involves tailoring an elliptical patch to cover the narrowed segment, which is then sutured in place to enhance the diameter and improve blood flow. Alternatively, if excision is performed, a new tubular segment of vein or a nonautogenous graft is sutured to the remaining segments of the graft or blood vessels. The procedure concludes with the release of vessel loops, verification of hemostasis, and completion angiography to confirm the patency of the revised AV fistula.