CPT® Code 35251

1. Indications

The procedure described by CPT® Code 35251 is indicated for the repair of an intra-abdominal blood vessel that has been compromised due to various conditions. The following are specific indications for performing this procedure:

• Trauma: Injury to the abdominal blood vessels resulting from accidents or penetrating injuries.
• Vascular Disease: Conditions such as aneurysms or occlusions that necessitate surgical intervention to restore blood flow.
• Congenital Anomalies: Structural abnormalities in blood vessels that may require surgical correction.

2. Procedure

The procedure for repairing an intra-abdominal blood vessel with a vein graft involves several critical steps, each essential for successful outcomes.

• Step 1: Exposure of the Injured Vessel The surgeon begins by making an incision to access the abdominal cavity and expose the injured blood vessel. This step is crucial as it allows for direct visualization and manipulation of the affected area.
• Step 2: Clamping the Vessel Once the vessel is exposed, clamps are applied both proximal and distal to the injury site. This clamping is necessary to control bleeding and create a bloodless field for the repair.
• Step 3: Evaluation of the Injury The extent of the injury is then assessed. This evaluation helps the surgeon determine the appropriate length and type of graft needed for the repair.
• Step 4: Harvesting the Vein A segment of vein, typically the saphenous vein from the lower leg, is harvested. This vein is chosen for its suitability as a graft due to its size and structure.
• Step 5: Preparing the Graft The harvested vein is prepared for grafting. This preparation may involve cleaning and sizing the vein to ensure it fits properly with the injured vessel.
• Step 6: Debriding the Vessel Edges The edges of the injured blood vessel are debrided to remove any damaged tissue. This step is vital for ensuring a clean surface for the graft to adhere to.
• Step 7: Suturing the Graft The prepared vein graft is then sutured to the proximal and distal ends of the injured blood vessel. This connection restores continuity and allows for normal blood flow through the graft.
• Step 8: Releasing the Clamps After the graft is securely in place, the clamps are released. The surgeon checks for hemostasis, ensuring that there is no bleeding along the suture line.
• Step 9: Repairing Overlying Tissues Finally, the overlying tissues are repaired in layers using sutures. This step is important for restoring the integrity of the abdominal wall and promoting proper healing.

3. Post-Procedure

Post-procedure care following the repair of an intra-abdominal blood vessel with a vein graft involves monitoring for complications and ensuring proper recovery. Patients are typically observed for signs of bleeding, infection, or graft failure. Pain management is also an important aspect of post-operative care. The surgical site may require dressing changes, and patients are advised on activity restrictions to promote healing. Follow-up appointments are essential to assess the success of the graft and the overall recovery process. Additionally, any specific instructions regarding diet, wound care, and medication adherence should be provided to the patient to facilitate optimal recovery.