by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
Question:
Patient has pre-existing brachiocephalic av fistula which now has aneurysms. Physician resects the cephalic vein from where it was anastomosed to the brachial artery. A subcutaneous tunnel was then made distal to the antecubital fossa with the distal cephalic vein brought in juxtaposition to the previous brachial artery anastomosis. The anastomotic segment was cleared to allow for end-to-side anastomosis to be completed from the brachial artery to the cephalic vein. This was then completed.
Due to lack of significant palpable thrill, in order to better provide outflow from this retrograde system, incision was made overlying the basilic vein in the forearm. Subcutaneous tunnel was made and the distended basilic vein was passed through. Distal basilic vein was transposed and juxtaposed to the cephalic vein. A venotomy was made within the cephalic vein and the basilic vein spatulated to accommodate an end-to-side anastomosis.
Since original anastomotic site used, is this revision (36832) or new creation (36819)?
Answer:
Go with revision here when any part of an existing fistula/graft is used.
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