CPT® Code 36833

An open revision of an arteriovenous (AV) fistula is a surgical procedure aimed at correcting complications that may arise from the formation of stenosis, thrombus, or occlusion in an AV fistula, particularly those created using a graft. This procedure is necessary when the normal blood flow through the fistula is compromised, which can lead to inadequate dialysis treatment for patients with renal failure. The operation 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. Once exposed, the blood vessels and graft are carefully dissected from the surrounding tissue to facilitate further intervention. The use of vessel loops is critical in this procedure, as they help control blood flow by clamping the vessels both proximal and distal to the stenosed area. If a thrombus, or blood clot, is identified, it is removed through direct exposure, which may involve opening the affected artery, vein, or graft. The removal of the thrombus can be aided by applying arterial back pressure or using massage techniques to expel the clot effectively. Following the thrombus removal, the revision of the graft is performed, which 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. If a patch graft is utilized, a segment of vein, often harvested from the saphenous vein, is tailored to fit over the stenosed area, enhancing the diameter and improving blood flow. Alternatively, if excision is necessary, a new tubular segment of vein or a nonautogenous graft is prepared and sutured to the remaining segments of the graft or blood vessels. The procedure concludes with the release of vessel loops, checking for hemostasis, and performing completion angiography to confirm that the revised AV fistula is patent and functioning properly.