Please see the link and FAQ info below from Fistula First.
http://www.fistulafirst.org/Professionals/FrequentlyAskedQuestions.aspx#Q25
Q: As part of the FFBI, you have suggested that a "full range of appropriate surgical approaches to AVF evaluation and placement" be considered. Does this mean you do not encourage the use of non-standard techniques? Is it considered standard technique to raise the brachiocephalic vein closer to the skin through the use of suction-assisted lipectomy? I am not familiar with this technique as it relates to vascular surgery procedures (I have seen it used in cosmetic surgery procedures only), can you suggest any references or reading materials that might be of help?
A: First, the intent of "a full range of appropriate surgical approaches" is to recommend that surgeons doing access be familiar with the various AVF procedures beyond the older, simpler procedures that limited AVF options. The newer procedures include the transpositions and others ? all of which have been established as viable AVF options by clinical trials and reporting in peer-reviewed publications. With respect to newer AVF procedures, such as experimental procedures that have not yet been established in the manner above, Fistula First neither endorses nor rejects these as AVF options ? until such time as evidence supports one position or the other. The specific procedure to which you refer is fairly new and is currently being used by some surgeons, in lieu of a surgical transposition, to bring the skin close to the vein (AVF) by removing the intervening fat layer to allow for safe and easy cannulation. It is the equivalent of a vein transposition, whereby the vein is surgically moved to a superficial position. It certainly appears to be a viable concept, in that it would obviate the need for a more involved surgical procedure to move the vein. Hopefully, clinical trails will support the use and standardization of this procedure. Until then, Fistula First would have no position on this procedure, one way or the other. Fistula First does not discourage the trial and use of any AVF procedure; in fact, quite the contrary. For example, all of the newer transpositions were at some time "non-standard", but with trials and reporting that provided evidence and outcomes that justified their use, they became standard options that could be recommended. Simply stated, Fistula First does not dictate practice, but will make recommendations when certain scientific criteria are met. (L. Spergel, MD)
This issue was posed as a question to Dr. Z on 8/7/12 in case you have access to view the response. Here is the link to the question referencing procedure codes 36832/37799/15878:
http://zhealthpublishing.com/zquestions/index/search/term/37799/?dir=asc&order=title
Someone else might be able to give you additional assistance.
Thanks.
Jean Kayser CPC CIRCC