CPT® Code 37160

1. Indications

The open caval-mesenteric venous anastomosis procedure is indicated for specific clinical scenarios where there is a need to improve venous drainage or address complications related to venous obstruction. The following conditions may warrant this surgical intervention:

• Portal Hypertension - A condition characterized by increased blood pressure in the portal venous system, often leading to complications such as varices.
• Mesenteric Venous Thrombosis - The presence of a thrombus in the mesenteric veins, which can impair blood flow and lead to ischemia of the intestines.
• Chronic Venous Insufficiency - A condition where the veins cannot pump enough blood back to the heart, potentially leading to swelling and discomfort.

2. Procedure

The open caval-mesenteric venous anastomosis procedure involves several critical steps to ensure successful anastomosis between the superior mesenteric vein and the inferior vena cava. The following procedural steps are typically performed:

• Step 1: Incision A vertical midline incision is made in the abdomen to provide access to the abdominal cavity. This incision allows the surgeon to visualize and manipulate the necessary structures effectively.
• Step 2: Retraction of the Colon The colon is retracted toward the head to expose the superior mesenteric vein at the root of the mesentery. This retraction is crucial for gaining access to the vascular structures involved in the anastomosis.
• Step 3: Isolation of the Superior Mesenteric Vein A section of the superior mesenteric vein is carefully isolated to prepare it for anastomosis. This step is essential to ensure that the vein is free from surrounding tissues and can be manipulated without risk of injury.
• Step 4: Mobilization of the Duodenum The duodenum is mobilized to facilitate exposure of the inferior vena cava. This mobilization is necessary to access the inferior vena cava anteriorly and laterally at the level of the iliac bifurcation.
• Step 5: Clamping the Inferior Vena Cava A side-biting clamp is placed on the inferior vena cava to control blood flow during the anastomosis. This step is critical to minimize blood loss and ensure a clear surgical field.
• Step 6: Anastomosis The proximal portion of the superior mesenteric vein is anastomosed to the side of the inferior vena cava. Alternatively, if a synthetic graft is used, it is first anastomosed to the side of the inferior vena cava and then to the side of the superior mesenteric vein, creating a new pathway for venous blood flow.

3. Post-Procedure

After the completion of the open caval-mesenteric venous anastomosis, patients typically require careful monitoring for any complications that may arise. Post-procedure care includes managing pain, monitoring for signs of infection, and ensuring proper healing of the surgical site. Patients may also need to be observed for any signs of venous thrombosis or other vascular complications. Recovery time can vary based on the individual patient's health status and the complexity of the procedure, but follow-up appointments are essential to assess the success of the anastomosis and the overall recovery process.