CPT® Code 35563

1. Indications

The ilioiliac bypass graft procedure (CPT® Code 35563) is indicated for patients experiencing significant vascular obstruction in the iliac arteries, which may lead to symptoms such as claudication, ischemic rest pain, or critical limb ischemia. This procedure is typically performed when less invasive treatments are ineffective or when there is a need to restore adequate blood flow to the lower extremities due to conditions such as atherosclerosis or other vascular diseases.

• Claudication - Pain or cramping in the legs during physical activity due to inadequate blood flow.
• Ischemic Rest Pain - Severe pain in the legs or feet while at rest, indicating critical blood flow issues.
• Critical Limb Ischemia - A severe obstruction of blood flow to the extremities, which can lead to tissue loss or gangrene.

2. Procedure

The ilioiliac bypass graft procedure involves several critical steps to ensure successful graft placement and restoration of blood flow. The first step is to open the abdomen to expose the iliac arteries. This allows the surgeon to carefully dissect both iliac arteries free from surrounding tissue, ensuring clear access for the graft placement.

• Step 1: The abdomen is opened, and both iliac arteries are exposed and dissected free of surrounding tissue. This step is crucial for gaining access to the arteries that will be involved in the bypass.
• Step 2: An abdominal tunnel is created to facilitate the placement of a cross-over graft from one iliac artery to the other. This tunnel allows the graft to be positioned without excessive tension or kinking.
• Step 3: 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 vein is carefully dissected free from surrounding soft tissue. Branches of the vein are ligated and divided, and the selected segment is ligated proximally and distally, divided, and removed from the leg.
• Step 4: The iliac artery on the unobstructed side is clamped and incised. The proximal end of the vein graft is then sutured to this artery, establishing the first connection of the bypass.
• Step 5: The graft is passed through the abdominal tunnel to the contralateral iliac artery. This step is essential for completing the bypass route.
• Step 6: The contralateral iliac artery is clamped and incised, and the distal end of the graft is sutured to this artery, completing the bypass connection.
• Step 7: After both anastomoses are completed, vascular clamps are released. The surgeon checks the suture lines for hemostasis to ensure there is no bleeding at the graft sites.
• Step 8: Finally, blood flow through the graft is assessed using Doppler ultrasound, and distal pulses are evaluated to ensure the patency of the bypass graft.

3. Post-Procedure

Post-procedure care for patients undergoing an ilioiliac bypass graft includes monitoring for any signs of complications, such as bleeding or infection at the surgical site. Patients are typically observed for adequate blood flow to the lower extremities, and follow-up Doppler studies may be performed to assess graft patency. Pain management and rehabilitation may be initiated to promote recovery and improve mobility. Patients are advised on lifestyle modifications and may require follow-up appointments to monitor their vascular health and the success of the graft.