CPT® Code 36836

Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation

A percutaneous arteriovenous fistula (AVF) creation is a minimally invasive procedure designed for patients with end-stage renal disease (ESRD) who require hemodialysis. This procedure involves the formation of a direct connection between a peripheral artery and a peripheral vein in the upper extremity, typically the arm, using a single access point. The primary goal of creating an AVF is to establish a reliable vascular access for hemodialysis, which is essential for patients undergoing treatment for kidney failure. The procedure is performed under imaging guidance, which allows for precise navigation and placement of instruments, ensuring that the artery and vein are accurately approximated. During the procedure, local anesthesia is administered to minimize discomfort, and ultrasound guidance is utilized to visualize the target vessels. A micropuncture needle is employed to access the vein, and through careful maneuvering, the needle is directed to puncture the adjacent artery. This connection is crucial as it facilitates the flow of blood from the artery into the vein, which is then matured to accommodate the demands of hemodialysis. The procedure may also include additional techniques such as transluminal balloon angioplasty or coil embolization to enhance the fistula's functionality. Overall, this procedure is vital for ensuring that patients have adequate access for their hemodialysis treatments, ultimately improving their quality of life and health outcomes.