CPT® Code 35512

1. Indications

The subclavian-brachial bypass graft procedure is indicated for specific conditions that necessitate the rerouting of blood flow due to arterial obstruction. The following are the primary indications for this surgical intervention:

• Occlusion in the Axillary or Proximal Brachial Artery - This procedure is performed to bypass an obstruction in the axillary or proximal brachial artery on the ipsilateral side, which can lead to compromised blood flow to the arm.
• Severe Vascular Trauma - Less commonly, this bypass graft may be indicated in cases of significant vascular trauma affecting the chest wall, shoulder, and upper arm, where normal blood flow is disrupted.

2. Procedure

The subclavian-brachial bypass graft procedure involves several critical steps to ensure successful rerouting of blood flow. The following outlines the procedural steps in detail:

• Step 1: Incision and Exposure of the Subclavian Artery - An incision is made at the base of the neck, just above the clavicle, to expose the subclavian artery. This access point is crucial for the subsequent steps of the procedure.
• Step 2: Incision and Exposure of the Brachial Artery - A second incision is made in the arm, typically just above the elbow, to expose the brachial artery. This allows for the connection of the vein graft to the brachial artery.
• Step 3: Creation of the Tunnel - A tunnel is created that begins at the exposed section of the subclavian artery and passes under the clavicle. This tunnel continues through the axillary region and down the arm, terminating at the planned anastomosis site in the brachial artery.
• Step 4: Harvesting the Vein Graft - A saphenous vein graft is harvested from the leg, as previously described, ensuring that it is suitable for use in the bypass.
• Step 5: Clamping and Incising the Subclavian Artery - Vascular clamps are applied to the subclavian artery, and the artery is incised to prepare for the attachment of the vein graft.
• Step 6: Suturing the Vein Graft to the Subclavian Artery - The harvested vein graft is sutured to the subclavian artery, establishing the first connection in the bypass.
• Step 7: Passing the Vein Graft Through the Tunnel - The vein graft is then carefully passed through the previously created tunnel, ensuring it is positioned correctly for the next connection.
• Step 8: Clamping and Incising the Brachial Artery - The brachial artery is clamped and incised, preparing it for the attachment of the vein graft.
• Step 9: Suturing the Vein Graft to the Brachial Artery - The vein graft is sutured to the brachial artery, completing the bypass route for blood flow.
• Step 10: Final Checks - The vascular clamps are removed, and blood flow through the graft is checked using Doppler ultrasound. Additionally, distal pulses are evaluated to ensure the patency of the bypass graft.

3. Post-Procedure

After the completion of the subclavian-brachial bypass graft procedure, careful monitoring and post-operative care are essential. Patients are typically observed for any signs of complications, such as bleeding or infection at the incision sites. The surgical team will assess the effectiveness of the graft by checking blood flow and distal pulses. Patients may be advised on activity restrictions and follow-up appointments to monitor the graft's function and overall recovery. Pain management and wound care instructions will also be provided to ensure a smooth recovery process.