CPT® Code 35511

1. Indications

The subclavian-subclavian bypass graft procedure (CPT® Code 35511) is indicated for patients experiencing significant disease or obstruction of the proximal subclavian artery, which may lead to compromised blood flow to the contralateral subclavian artery. This condition can manifest as symptoms such as claudication, ischemic pain, or other vascular insufficiencies. The procedure aims to restore adequate blood circulation and alleviate symptoms associated with vascular obstruction.

• Disease or obstruction of the proximal subclavian artery This condition necessitates the creation of a bypass to ensure proper blood flow to the contralateral subclavian artery.

2. Procedure

The subclavian-subclavian bypass graft procedure involves several critical steps to ensure successful grafting and restoration of blood flow. Initially, an incision is made at the base of the neck, just above the clavicle, to expose the first subclavian artery. This exposure allows the surgeon to assess the condition of the artery and prepare for the grafting process. A similar incision is then made on the opposite side to access the second subclavian artery, ensuring that both arteries are adequately prepared for the bypass.

• Step 1: An incision is made at the base of the neck above the clavicle to expose the first subclavian artery.
• Step 2: A second incision is made on the opposite side to expose the second subclavian artery.
• Step 3: A tunnel is created across the chest, connecting the two subclavian arteries, which will accommodate the vein graft.
• Step 4: A vein graft is harvested, typically from the saphenous vein in the leg. This involves making an incision in the leg, dissecting the soft tissue, and ligating and dividing branches of the saphenous vein.
• Step 5: The section of the saphenous vein to be used is ligated proximally and distally, divided, and removed from the leg.
• Step 6: Vascular clamps are applied to the first subclavian artery, and the artery is incised to prepare for the graft.
• Step 7: The vein graft is sutured to the first subclavian artery, establishing the first connection.
• Step 8: The vein graft is then passed through the previously created tunnel to reach the second subclavian artery.
• Step 9: The second subclavian artery is clamped and incised, allowing for the attachment of the graft.
• Step 10: The vein graft is sutured to the second subclavian artery, completing the bypass connection.
• Step 11: Vascular clamps are removed, and blood flow through the graft is checked using Doppler ultrasound to ensure patency.
• Step 12: Distal pulses are evaluated to confirm adequate blood flow and the success of the bypass graft.

3. Post-Procedure

After the completion of the subclavian-subclavian bypass graft procedure, patients are typically monitored for any signs of complications, such as bleeding or infection at the incision sites. Recovery may involve pain management and monitoring of vascular status to ensure the graft is functioning properly. Patients may be advised on activity restrictions and follow-up appointments to assess the success of the graft and overall recovery. It is essential to evaluate the patency of the graft through Doppler studies during follow-up visits to ensure that blood flow remains adequate and that there are no obstructions in the newly created pathway.