CPT® Code 35536

Official Description

Bypass graft, with vein; splenorenal

Common Language Description

A splenorenal vein bypass graft is a surgical procedure designed to create a new pathway for blood flow around a diseased or obstructed segment of the renal artery, which supplies blood to the kidney. This procedure is essential for restoring adequate blood circulation to the kidney, thereby preventing potential damage due to ischemia. The operation involves several critical steps, beginning with an incision in the abdomen to access the necessary anatomical structures. The omentum, a fold of peritoneum extending from the stomach, is carefully separated from the transverse colon to provide a clear view of the celiac axis, which includes vital arteries such as the hepatic, left gastric, and splenic arteries. During the procedure, the splenic artery is isolated, and the descending duodenum is mobilized to facilitate access to the inferior vena cava and renal vein. The inferior vena cava, a major vein that carries deoxygenated blood from the lower body to the heart, is also mobilized, and the renal artery is isolated to prepare for the grafting process. A vein graft, typically harvested from the saphenous vein in the leg, is prepared for use. The harvesting process involves making an incision over the selected section of the saphenous vein, dissecting the surrounding soft tissue, and ligating and dividing any branches of the vein. Once the appropriate segment of the saphenous vein is removed, vascular clamps are applied to the splenic artery, and an incision is made to facilitate the attachment of the vein graft. The vein graft is then sutured in an end-to-side configuration to the splenic artery, allowing blood to flow into the graft. Subsequently, the renal artery is clamped and incised, and the vein graft is anastomosed in an end-to-side manner, effectively bypassing the obstructed area of the renal artery. After the clamps are released, the blood flow through the graft is verified using Doppler ultrasound, ensuring that the procedure has successfully restored circulation to the kidney.

1. Indications

The splenorenal vein bypass graft procedure is indicated for patients who present with specific conditions affecting the renal artery. These indications include:

Renal Artery Stenosis - A narrowing of the renal artery that can lead to reduced blood flow to the kidney, potentially causing hypertension and kidney dysfunction.
Renal Artery Occlusion - A complete blockage of the renal artery, which can result in ischemia and damage to the kidney tissue.
Ischemic Nephropathy - A condition characterized by kidney damage due to insufficient blood supply, often resulting from renal artery disease.

2. Procedure

The procedure for a splenorenal vein bypass graft involves several detailed steps to ensure successful grafting and restoration of blood flow. The steps are as follows:

Step 1: Abdominal Incision - The surgeon begins by making an incision in the abdomen to gain access to the necessary anatomical structures. This incision allows for the separation of the omentum from the transverse colon, providing a clear view of the celiac axis.
Step 2: Celiac Axis Exposure - The celiac axis, which includes the hepatic, left gastric, and splenic arteries, is evaluated. The splenic artery is then isolated to prepare for the grafting process.
Step 3: Mobilization of Structures - The descending duodenum is mobilized to facilitate access to the inferior vena cava and renal vein. The inferior vena cava is also mobilized, and the renal artery is isolated for the upcoming grafting procedure.
Step 4: Harvesting the Vein Graft - 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 surrounding soft tissue is dissected away. Saphenous vein branches are ligated and divided, and the selected segment of the vein is ligated proximally and distally, then removed from the leg.
Step 5: Graft Attachment - Vascular clamps are applied to the splenic artery, and an incision is made in the artery. The harvested vein graft is then sutured in an end-to-side configuration to the splenic artery, establishing a new pathway for blood flow.
Step 6: Anastomosis to Renal Artery - The renal artery is clamped and incised, and the vein graft is anastomosed in an end-to-side manner, effectively bypassing the diseased or obstructed portion of the renal artery.
Step 7: Verification of Blood Flow - After the clamps are released, the surgeon checks the blood flow through the graft using Doppler ultrasound to ensure that the procedure has successfully restored circulation to the kidney.

3. Post-Procedure

Post-procedure care for patients who have undergone a splenorenal vein bypass graft includes monitoring for any complications, such as bleeding or infection at the incision sites. Patients are typically observed for signs of adequate blood flow to the kidney, and follow-up imaging may be performed to assess the patency of the graft. Pain management and gradual mobilization are also important aspects of post-operative care to promote recovery. Patients may be advised on lifestyle modifications and medication adherence to support kidney health and prevent future vascular complications.

Short Descr	ART BYP GRFT SPLENORENAL
Medium Descr	BYPASS W/VEIN SPLENORENAL
Long Descr	Bypass graft, with vein; splenorenal
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)