CPT® Code 35516

1. Indications

The subclavian-axillary bypass graft procedure is indicated for patients experiencing conditions that lead to obstruction or disease of the axillary artery. These conditions may include:

• Arterial Occlusion - Blockage of the axillary artery due to atherosclerosis or thrombosis.
• Peripheral Vascular Disease - A condition characterized by narrowed arteries reducing blood flow to the limbs.
• Trauma - Injury to the axillary artery that compromises blood flow.
• Congenital Anomalies - Structural abnormalities of the blood vessels that may necessitate bypass surgery.

2. Procedure

The procedure for a subclavian-axillary bypass graft involves several critical steps to ensure successful grafting and restoration of blood flow. The steps are as follows:

• Step 1: Incision and Exposure - The surgeon begins by making an incision at the base of the neck, just above the clavicle, to access the subclavian artery. A second incision is then made in the chest, just below the collarbone, to expose the axillary artery. This careful dissection of soft tissue allows for clear visibility and access to the arteries involved in the bypass.
• Step 2: Creating the Tunnel - Once both arteries are exposed, the surgeon creates a tunnel that connects the subclavian artery to the axillary artery. This tunnel is formed by passing under the clavicle, facilitating the placement of the vein graft.
• Step 3: Harvesting the Vein Graft - A vein graft is harvested, typically from the saphenous vein in the leg. The surgeon makes an incision over the section of the saphenous vein to be used, dissects the soft tissue away from the vein, and ligates and divides its branches. The selected section of vein is then ligated proximally and distally, divided, and removed from the leg.
• Step 4: Grafting Procedure - Vascular clamps are applied to the subclavian artery, and an incision is made in the artery. The harvested vein graft is then sutured to the subclavian artery. The graft is passed through the previously created tunnel to reach the axillary artery.
• Step 5: Finalizing the Graft - The axillary artery is clamped and incised, and the other end of the vein graft is sutured to the axillary artery. After ensuring that the graft is securely in place, the vascular clamps are removed.
• Step 6: Verification of Blood Flow - The surgeon checks for blood flow through the graft using Doppler ultrasound. Additionally, distal pulses are evaluated to confirm the patency of the bypass graft, ensuring that blood is flowing properly through the newly created pathway.

3. Post-Procedure

After the subclavian-axillary bypass graft procedure, patients are typically monitored for any complications and to ensure proper recovery. Post-operative care may include pain management, monitoring of vital signs, and assessment of the graft site for any signs of infection or complications. Patients may be advised to engage in gradual rehabilitation exercises to restore mobility and strength in the affected arm. Follow-up appointments are essential to evaluate the success of the graft and to monitor for any potential issues with blood flow.