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An aorto-subclavian, aorto-innominate, or aorto-carotid bypass graft using a vein is a surgical procedure designed to create a new pathway for blood flow around a diseased or obstructed segment of the subclavian, innominate, or carotid artery. This procedure is essential for restoring adequate blood circulation to areas that may be compromised due to arterial blockages. The surgery involves the use of a vein graft, which is typically harvested from the patient's own body, often from the saphenous vein in the leg. The operation begins with an incision made in the neck for access to the common carotid artery or a supraclavicular incision for the subclavian or innominate arteries. During the procedure, careful dissection of soft tissues is performed to expose the affected artery, and vascular clamps are applied to control blood flow. The vein graft is then meticulously sutured to both the affected artery and the aorta, ensuring that blood can bypass the obstructed area effectively. This surgical intervention is critical for patients experiencing significant arterial disease, as it helps to alleviate symptoms and prevent complications associated with reduced blood flow.
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The aorto-subclavian, aorto-innominate, or aorto-carotid bypass graft procedure is indicated for patients who present with specific conditions affecting the arteries involved. These indications may include:
The aorto-subclavian, aorto-innominate, or aorto-carotid bypass graft procedure involves several critical steps to ensure successful grafting and restoration of blood flow. The procedure begins with the patient being placed under general anesthesia. A surgical incision is made in the neck over the common carotid artery for aorto-carotid bypass, or a supraclavicular incision may be made for aorto-subclavian or aorto-innominate bypass. The surgeon carefully dissects the soft tissues to expose the artery, taking care to mobilize any surrounding nerves and veins. Once the carotid artery is adequately exposed, vascular clamps are applied to the artery above and below the planned incision site to control blood flow during the procedure.
Next, a vein graft is harvested, typically from the saphenous vein in the leg. An incision is made over the section of the saphenous vein to be used, and the surrounding soft tissue is dissected away. Branches of the vein are ligated and divided, and the selected segment of the vein is ligated proximally and distally, divided, and removed from the leg. With the vein graft prepared, the surgeon proceeds to incise the affected artery and sutures the venous graft to it. A side-biting clamp is then placed on the aorta at the planned incision site, allowing the aorta to be incised and the venous graft to be sutured to the aorta. After the graft is securely in place, the vascular clamps are released, and the surgeon checks the suture lines for hemostasis to ensure there is no bleeding.
Following the aorto-subclavian, aorto-innominate, or aorto-carotid bypass graft procedure, patients are typically monitored in a recovery area for any immediate complications. Post-operative care includes managing pain, monitoring vital signs, and ensuring proper blood flow through the graft. Patients may be advised to limit physical activity for a specified period to promote healing. Follow-up appointments are essential to assess the success of the graft and to monitor for any potential complications, such as graft occlusion or infection. The healthcare team will provide specific instructions regarding wound care, medication management, and lifestyle modifications to support recovery and overall vascular health.
| Short Descr | ART BYP GRFT AOR/CAROT/INNOM | Medium Descr | BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE | Long Descr | Bypass graft, with vein; aortosubclavian, aortoinnominate, or aortocarotid | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 56 - Other vascular bypass and shunt, not heart |
This is a primary code that can be used with these additional add-on codes.
| 35572 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Harvest of femoropopliteal vein, 1 segment, for vascular reconstruction procedure (eg, aortic, vena caval, coronary, peripheral artery) (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | LT | Left side (used to identify procedures performed on the left side of the body) |
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Notes
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2011-01-01 | Changed | Long description revised. Medium description changed. |
| Pre-1990 | Added | Code added. |
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