CPT® Code 35537

1. Indications

The bypass graft procedure is indicated for patients who present with significant obstruction or disease in the lower aorta that impairs blood flow to the iliac arteries. This condition may manifest as claudication, ischemic rest pain, or other symptoms related to inadequate blood supply to the lower extremities. The procedure is typically considered when non-invasive treatments have failed or when the severity of the obstruction necessitates surgical intervention to restore proper circulation.

• Obstructed Aorta The procedure is performed to bypass a diseased or obstructed segment of the lower aorta.
• Insufficient Blood Flow Indicated for patients experiencing symptoms due to inadequate blood supply to the iliac arteries.
• Failed Non-Invasive Treatments Considered when less invasive options have not provided relief or improvement.

2. Procedure

The bypass graft procedure involves several critical steps to ensure successful implementation. First, the surgeon makes a lower abdominal incision to gain access to the aorta. Once the aorta is exposed, clamps are applied above the diseased area to control blood flow during the procedure. In some cases, the aorta may be tied off above the obstruction to facilitate the grafting process. The next step involves harvesting a vein from the patient or a donor, which will serve as the graft. One end of this vein graft is then sutured to the aorta, establishing a new pathway for blood flow. To verify the integrity of the anastomosis, a vessel clamp is placed on the venous graft while the aortic clamp is released, allowing the surgeon to check for any leaks at the connection site. Following this, the iliac artery is clamped distal to the anastomosis site to prepare for the next connection. Through a separate incision, the other end of the vein graft is sutured into the iliac artery. The surgeon will again check for leaks and ensure that the graft is patent before proceeding to close the abdominal incision. This meticulous process ensures that blood can effectively bypass the obstructed portion of the aorta, restoring circulation to the lower extremities.

• Step 1: Incision A lower abdominal incision is made to access the aorta.
• Step 2: Clamping Clamps are applied above the diseased portion of the aorta to control blood flow.
• Step 3: Vein Harvesting A vein is harvested from the patient or a donor to be used as the graft.
• Step 4: Suturing to Aorta One end of the vein graft is sutured to the aorta, establishing a new blood flow pathway.
• Step 5: Leak Testing A vessel clamp is placed on the venous graft while the aortic clamp is released to check for leaks.
• Step 6: Clamping Iliac Artery The iliac artery is clamped distal to the anastomosis site.
• Step 7: Suturing to Iliac Artery The other end of the vein graft is sutured into the iliac artery.
• Step 8: Final Checks The graft site is checked for leaks and patency before closing the incision.

3. Post-Procedure

After the bypass graft procedure, patients are typically monitored in a recovery area to ensure stable vital signs and to assess for any immediate complications. Post-operative care may include pain management, monitoring for signs of infection, and ensuring proper blood flow through the graft. Patients may be advised on activity restrictions and follow-up appointments to evaluate the success of the graft and overall recovery. It is essential to monitor the graft site for any signs of leakage or complications, and patients may undergo imaging studies to assess graft patency during follow-up visits.