CPT® Code 35022

1. Indications

The procedure described by CPT® Code 35022 is indicated for the surgical repair of a ruptured aneurysm or pseudoaneurysm of the innominate or subclavian artery. The following conditions may warrant this procedure:

• Ruptured Aneurysm - A life-threatening condition where the aneurysm has burst, leading to significant internal bleeding.
• Pseudoaneurysm - A condition where a hematoma forms in communication with the artery wall, often due to trauma or procedural complications.
• Associated Occlusive Disease - Conditions that may accompany the aneurysm, affecting blood flow and necessitating surgical intervention.

2. Procedure

The surgical procedure for CPT® Code 35022 involves several critical steps to ensure effective repair of the aneurysm:

• Preparation and Anesthesia - The patient is positioned appropriately, and general anesthesia is administered to ensure comfort and immobility during the procedure.
• Incision - A median sternotomy is performed, which involves making an incision along the sternum. This incision may be extended into the supraclavicular region or neck as necessary to gain adequate access to the innominate or subclavian artery.
• Exposure of the Artery - The left brachiocephalic vein is either divided or mobilized to expose the innominate or subclavian artery. The artery is then clamped to control blood flow during the repair process.
• Aneurysm Sac Management - The aneurysm sac is opened, and any thrombus or plaque present within the sac is carefully removed to prepare the artery for repair.
• Repair Techniques - The artery walls are sutured together, and an autogenous (saphenous vein) or synthetic patch graft may be applied as needed. Alternatively, the aneurysm may be excised, followed by direct repair through end-to-end anastomosis of the vessel ends, with or without a patch graft. Another option is to insert a tube graft, which involves making a longitudinal incision in the artery, inserting the graft, and suturing it to the healthy artery above and below the aneurysm.
• Closure - After the graft is secured, the aneurysm sac is closed over the graft. The clamps are then released to restore blood flow through the artery.

3. Post-Procedure

Post-procedure care for patients undergoing the repair of a ruptured aneurysm includes monitoring for complications such as bleeding, infection, or graft failure. Patients are typically observed in a recovery area before being transferred to a hospital room for further monitoring. Pain management is provided, and vital signs are closely monitored. The expected recovery period may vary based on the patient's overall health and the complexity of the procedure. Follow-up appointments are essential to assess the success of the repair and to monitor for any potential complications or need for further intervention.