CPT® Code 35683

Add-On Code

1. Indications

The procedure associated with CPT® Code 35683 is indicated for patients who require a bypass graft due to insufficient vein availability in the limb undergoing the procedure. The following conditions may warrant the use of this surgical intervention:

• Insufficient Vein Segments Patients who do not have an adequate segment of vein in the limb that is being treated for the bypass procedure.
• Peripheral Artery Disease Individuals suffering from peripheral artery disease, where blood flow is restricted due to narrowed arteries, may require this procedure to restore circulation.
• Venous Insufficiency Patients with venous insufficiency may also be candidates for this procedure if their veins are not suitable for use in the bypass graft.

2. Procedure

The procedure for CPT® Code 35683 involves several critical steps to ensure the successful creation of an autogenous composite bypass graft. The following outlines the procedural steps:

• Step 1: Patient Preparation The patient is positioned appropriately, and the surgical site is prepared and sterilized to minimize the risk of infection. Anesthesia is administered to ensure the patient is comfortable throughout the procedure.
• Step 2: Harvesting Vein Segments The surgeon identifies and harvests three or more segments of vein from two or more locations in the patient's body. Common sites for vein harvesting include the contralateral greater saphenous vein, lesser saphenous vein, superficial femoral vein, or the cephalic and basilic veins in the arm. Care is taken to preserve the integrity of the veins during harvesting.
• Step 3: Creating the Composite Graft Once the vein segments are harvested, they are prepared for anastomosis. The surgeon may also obtain a prosthetic vein segment if necessary. The harvested vein segments are then meticulously anastomosed together to form a composite graft of the required length, ensuring that the connections are secure and that blood flow can be effectively restored.
• Step 4: Anastomosis to the Artery The composite graft is then anastomosed to the target artery, creating a new pathway for blood flow that bypasses the obstructed or diseased segment. This step is crucial for ensuring that the graft functions properly and that adequate circulation is restored to the affected limb.
• Step 5: Closure After the graft has been successfully placed, the surgical site is closed in layers, and the patient is monitored for any immediate postoperative complications.

3. Post-Procedure

Following the completion of the bypass graft procedure, patients are typically monitored in a recovery area to ensure stable vital signs and to assess for any complications. Post-procedure 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. Rehabilitation may also be recommended to help restore function and mobility in the affected limb.