CPT® Code 33802

1. Indications

The procedure described by CPT® Code 33802 is indicated for the treatment of vascular rings, which are associated with various symptoms and conditions resulting from the compression of the trachea and esophagus. The following are specific indications for performing this procedure:

• Vascular Compression Symptoms Symptoms such as stridor, wheezing, or respiratory distress due to tracheal compression.
• Swallowing Difficulties Dysphagia or difficulty swallowing caused by esophageal compression.
• Diagnostic Confirmation Confirmed diagnosis of a vascular ring through imaging studies such as echocardiography, MRI, or CT scans.
• Presence of Aberrant Vessels Identification of aberrant blood vessels that encircle the trachea and esophagus, leading to significant clinical symptoms.

2. Procedure

The procedure for the division of an aberrant vessel involves several critical steps to ensure effective repair of the vascular ring. The following outlines the procedural steps:

• Step 1: Left Thoracotomy A left thoracotomy is performed to access the thoracic cavity. This involves making an incision in the chest wall to provide the surgeon with direct access to the heart and surrounding structures.
• Step 2: Incision of the Pleura The pleura, which is the membrane surrounding the lungs, is incised to expose the vascular ring. This step is crucial for visualizing the aberrant vessels that need to be addressed.
• Step 3: Dissection of Soft Tissues The surgeon carefully dissects the soft tissues surrounding the vascular structures to evaluate the anatomy and identify the smaller arch that requires division.
• Step 4: Clamping the Smaller Arch A vascular clamp is placed on the smaller of the two arches. Blood flow is assessed by checking the right and left radial and carotid pulses; strong pulses indicate adequate blood flow through the larger arch.
• Step 5: Division of the Smaller Arch A second vascular clamp is applied to the smaller arch, which is then divided between the two clamps. This step is essential for relieving the compression on the trachea and esophagus.
• Step 6: Oversewing the Stumps The divided stumps of the smaller arch are oversewn with sutures to prevent bleeding and ensure proper closure of the vascular structures.
• Step 7: Transection of Adhesive Bands Any adhesive bands surrounding the esophagus are transected to further alleviate compression and restore normal anatomy.
• Step 8: Closure of the Thoracotomy The thoracotomy incision is closed, and air is evacuated from the pleural space using a small suction catheter to prevent complications such as pneumothorax.

3. Post-Procedure

Post-procedure care following the division of an aberrant vessel includes monitoring for any complications such as bleeding, infection, or respiratory distress. Patients are typically observed in a recovery area before being transferred to a regular hospital room. Pain management is provided as needed, and the surgical site is monitored for signs of infection or other complications. Patients may require follow-up imaging studies to ensure that the vascular structures are healing properly and that there is no recurrence of compression symptoms. Rehabilitation may also be necessary to support recovery and improve respiratory function.