CPT® Code 37735

1. Indications

The procedure described by CPT® Code 37735 is indicated for patients presenting with specific conditions related to venous insufficiency and associated complications. The following indications are explicitly recognized for this surgical intervention:

• Venous Ulcers: The presence of venous ulcers, which are open sores resulting from poor venous circulation, necessitates surgical intervention to promote healing and prevent further complications.
• Varicose Veins: Patients with symptomatic varicose veins, which can lead to discomfort, swelling, and cosmetic concerns, may require this procedure to alleviate symptoms and improve venous function.
• Chronic Venous Insufficiency: Individuals suffering from chronic venous insufficiency, characterized by inadequate blood flow from the lower extremities back to the heart, may benefit from the removal of affected veins to enhance venous return.

2. Procedure

The procedure for CPT® Code 37735 involves several critical steps to ensure effective treatment of the saphenous veins and associated conditions. The following procedural steps are outlined:

• Step 1: Exposure of the Saphenous Vein: The surgeon begins by making an incision over the saphenopopliteal junction to expose the short saphenous vein. This allows for the identification of the vein and its branches, which will be dissected and ligated.
• Step 2: Ligation and Division: Venous branches along the short saphenous vein are carefully dissected, and each branch is suture ligated and divided to isolate the vein from surrounding tissues. This step is crucial for preventing bleeding during the stripping process.
• Step 3: Clamping and Stripping: A second incision is made in the calf over the distal aspect of the short saphenous vein. The vein is clamped proximally and distally, and the distal end is ligated and divided below the clamp. A stripper is then inserted into the vein and advanced to the saphenopopliteal junction, where the proximal aspect of the vein is also divided and ligated.
• Step 4: Removal of the Vein: The stripper head is tied to the proximal end of the divided short saphenous vein, and the vein is pulled out through the calf incision, effectively removing the affected vein from the lower extremity.
• Step 5: Radical Excision of Ulcer: If venous ulcers are present, the surgeon performs a radical excision of the ulcer, ensuring that all affected tissue is removed to promote healing.
• Step 6: Skin Grafting: The physician then harvests skin from a separate donor site, configuring the skin graft to cover the defect created by the excision. The graft is sutured in place, and the donor site is repaired with sutures.
• Step 7: Interruption of Communicating Veins: The surgeon may also dissect and suture ligate any communicating veins in the lower leg, which are smaller veins that connect the superficial and deep venous systems, to further enhance venous circulation.
• Step 8: Excision of Deep Fascia: Finally, the deep fascia surrounding the communicating veins may be excised to facilitate better venous drainage and reduce the risk of future complications.

3. Post-Procedure

After the completion of the procedure, patients can expect specific post-operative care and considerations. The surgical site will require monitoring for signs of infection, proper healing of the skin graft, and management of any pain or discomfort. Patients may be advised to keep the affected leg elevated to reduce swelling and promote venous return. Follow-up appointments will be necessary to assess the healing process and ensure that the skin graft is integrating properly. Additionally, patients may receive instructions on activity restrictions and the importance of wearing compression garments to support venous circulation during the recovery phase. Overall, the post-procedure care is crucial for achieving optimal outcomes and preventing complications.