CPT® Code 36837

Percutaneous arteriovenous fistula creation, upper extremity, separate access sites of 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 surgical procedure designed specifically 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 separate access sites for each vessel. The primary goal of creating an AVF is to establish a reliable vascular access point that can withstand the repeated needle insertions required for hemodialysis treatments. The procedure is performed using image-guided techniques, which may include ultrasound and fluoroscopy, to accurately navigate and visualize the target vessels. During the procedure, the physician punctures the target vein under ultrasonic guidance, allowing for precise placement of a guidewire. This guidewire serves as a pathway for subsequent instruments, including dilators and sheaths, which facilitate access to the artery and vein. The use of advanced imaging techniques ensures that the physician can monitor the placement of the guidewires and catheters in real-time, enhancing the safety and efficacy of the procedure. Additionally, the AVF creation may involve various maturation procedures, such as transluminal balloon angioplasty or coil embolization, to optimize blood flow and ensure the fistula is functional for hemodialysis. The procedure concludes with imaging studies to confirm the patency of the newly created fistula and to assess blood flow dynamics. Overall, this procedure is critical for patients requiring long-term hemodialysis, as it provides a durable and effective means of vascular access.