CPT® Code 0744T

1. Indications

The insertion of a bioprosthetic valve into the femoral vein is indicated for the following conditions:

• Leg Ulcers - These are chronic wounds that can develop due to poor blood circulation in the veins, often leading to significant discomfort and complications.
• Deep Venous Reflux - This condition occurs when the valves in the veins fail to function properly, causing blood to flow backward and pool in the legs, which can result in swelling and pain.

2. Procedure

The procedure for the insertion of a bioprosthetic valve involves several critical steps to ensure successful placement and function of the valve:

• Accessing the Femoral Vein - The procedure begins with an incision made in the mid or upper thigh to access the femoral vein. This access point is crucial for performing the subsequent steps of the procedure.
• Mobilizing the Vein - Vessel loops are utilized to mobilize the femoral vein and control blood flow during the procedure. This step is essential to create a clear working area and to minimize blood loss.
• Administering Anticoagulation - Intravenous heparin is administered to prevent blood clotting during the procedure, ensuring that the surgical field remains clear and manageable.
• Applying Vascular Clamps - Vascular clamps are placed on either side of the exposed femoral vein. This allows for the vein to be opened safely without excessive bleeding.
• Opening the Vein - The vein is opened carefully, and the inflow side clamp is released briefly to allow for the insertion of a sizing dilator. This dilator helps in selecting the appropriate size of the bioprosthetic valve.
• Inserting the Bioprosthetic Valve - The selected V-shaped bioprosthetic valve is inserted through the venotomy, ensuring that the apex of the valve points downward toward the patient’s feet. This orientation is critical for proper function.
• Tacking the Valve - The inflow stabilization ring of the valve is tacked to the vein to secure its position, followed by suturing the venotomy closed to restore the integrity of the vein.
• Using a Patch Graft - If necessary, a patch graft may be employed to assist in closing the incision before the vascular clamps are removed, ensuring a secure closure.
• Testing Valve Function - To confirm that blood flows correctly through the newly inserted valve and that there are no leaks, the patient's calf muscle is squeezed. This step is vital for assessing the immediate functionality of the valve.
• Evaluating with Duplex Ultrasound - Finally, duplex ultrasound imaging is used to evaluate the proper function of the valve before the surgical wound is closed, ensuring that the valve is operating as intended.

3. Post-Procedure

After the procedure, patients are typically monitored for any signs of complications, such as bleeding or infection at the incision site. Recovery may involve pain management and instructions for activity restrictions to promote healing. Follow-up appointments are essential to assess the function of the bioprosthetic valve and to ensure that the patient is recovering appropriately. Duplex ultrasound may be utilized in follow-up visits to monitor the valve's performance and the overall condition of the venous system.