CPT® Code 33803

1. Indications

The procedure described by CPT® Code 33803 is indicated for patients presenting with symptoms or conditions associated with vascular rings, particularly those caused by aberrant vessels that lead to compression of the trachea and esophagus. The following conditions may warrant this surgical intervention:

• Vascular Compression Symptoms Patients may exhibit respiratory distress or difficulty swallowing due to the encirclement of the trachea and esophagus by aberrant blood vessels.
• Double Aortic Arch This condition involves two aortic branches that encircle the trachea and esophagus, necessitating surgical division to relieve compression.
• Right Aortic Arch with Anomalous Left Subclavian Artery This configuration can lead to tracheal compression and may require division and reanastomosis of the aberrant vessel to restore normal anatomy and function.

2. Procedure

The surgical procedure for CPT® Code 33803 involves several critical steps to effectively address the aberrant vessel and relieve compression on the trachea and esophagus. The following procedural steps are performed:

• Left Thoracotomy A left thoracotomy is initiated to access the thoracic cavity. This involves making an incision through the chest wall, typically through the fourth intercostal space, to gain access to the vascular structures.
• Incision of the Pleura The pleura, which is the membrane surrounding the lungs, is carefully incised to expose the underlying vascular ring. This step is crucial for visualizing the aberrant vessels.
• Dissection of Soft Tissues The surrounding soft tissues are meticulously dissected to evaluate the vascular structures involved in the vascular ring. This allows the surgeon to identify the smaller arch that requires division.
• Clamping and Evaluation of Blood Flow A vascular clamp is placed on the smaller of the two arches, and blood flow is assessed by checking the right and left radial and carotid pulses. Strong pulses indicate adequate blood flow through the larger arch.
• Division of the Smaller Arch A second vascular clamp is applied to the smaller arch, which is then divided between the two clamps. The stumps of the divided arch are oversewn with sutures to prevent bleeding.
• Transection of Adhesive Bands Any adhesive bands surrounding the esophagus are transected to further relieve compression and facilitate normal anatomical positioning.
• Closure of the Thoracotomy The thoracotomy is closed, and air is evacuated from the pleural space using a small suction catheter to prevent complications such as pneumothorax.
• Reanastomosis In cases involving a right aortic arch, the aorta is clamped and divided as previously described. The retroesophageal portion of the aorta is mobilized, and a graft may be utilized to lengthen the aorta. The ascending and descending portions are then reanastomosed to restore normal blood flow.

3. Post-Procedure

Post-procedure care following the division of the aberrant vessel and reanastomosis involves monitoring the patient for any complications related to the surgery. Patients are typically observed for signs of respiratory distress or bleeding. Pain management is provided as needed, and the surgical site is monitored for signs of infection. Patients may require follow-up imaging studies to assess the success of the procedure and ensure that normal blood flow has been restored. Recovery time may vary based on the individual patient's condition and the extent of the surgical intervention.