In simple words: The doctor creates a connection between a vein and an artery in the upper arm to make it easier to perform dialysis. This is often done for people with kidney problems who need dialysis to clean their blood.

This CPT code, 36818, represents the creation of an arteriovenous anastomosis (AVA) through an open surgical approach, specifically utilizing the cephalic vein transposition in the upper arm.The procedure involves creating a connection between the cephalic vein and the brachial artery. This surgical technique is often employed to establish vascular access for hemodialysis in patients with kidney failure. The procedure includes all necessary steps, from incision and dissection to anastomosis and wound closure.The surgeon creates a subcutaneous tunnel, dissects a portion of the cephalic vein, and then connects it to the brachial artery. Hemostasis (control of bleeding) and layered wound closure are integral parts of this procedure.

Example 1: A 60-year-old male with end-stage renal disease requires creation of an arteriovenous fistula for hemodialysis. The surgeon performs a cephalic vein transposition to the brachial artery in the left upper arm using code 36818., A 55-year-old female with chronic kidney disease needs vascular access for hemodialysis. The surgeon creates an arteriovenous fistula in her right upper arm using the cephalic vein and the brachial artery (code 36818). The procedure is performed under general anesthesia in an ambulatory surgical center., A 72-year-old patient with ESRD requires a new AV fistula.Due to limited venous access in the nondominant arm, the surgeon uses a cephalic vein transposition (code 36818) to the brachial artery in the left upper arm. Intraoperative ultrasound guidance is used to ensure optimal vessel placement. Post-operative Doppler ultrasound is performed to confirm patency and to rule out any complications.

Preoperative assessment including evaluation of suitability for AV fistula creation and assessment of suitable veins and arteries.Intraoperative documentation showing details of incision sites, vein and artery selection, tunnel creation, anastomosis technique, hemostasis, and closure.Post-operative documentation showing patency confirmation with Doppler ultrasound.

** This procedure is commonly performed by vascular surgeons in collaboration with nephrologists.Careful patient selection and meticulous surgical technique are crucial for success. Postoperative monitoring is important to ensure patency and to detect complications early.