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CPT®
33332

CPT® Code 33332
Deleted

Official Description

Insertion of graft, aorta or great vessels; with shunt bypass

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 33332 involves the insertion of a graft into the aorta or great vessels, specifically utilizing a shunt bypass technique. This surgical intervention is typically indicated in cases of injury to the aorta or great vessels, which can arise from either blunt or penetrating trauma. Such injuries may manifest as transections, ruptures, tears, or lacerations of the aorta or great vessels, necessitating prompt and effective repair to restore vascular integrity and ensure adequate blood flow. The use of a synthetic graft is crucial in these scenarios, as it provides a durable solution to replace or repair the damaged vessel. The shunt bypass method allows for continued blood perfusion to distal arteries during the surgical procedure, which is essential for maintaining organ function and preventing ischemia. This technique involves cannulation of the left ventricular apex, ascending aorta, or left subclavian artery, facilitating blood flow while the surgical repair is being performed. The procedure is complex and requires careful dissection and exposure of the injured vessels, ensuring that all anatomical structures are preserved and protected throughout the operation.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure is indicated for the following conditions:

  • Traumatic Injury Injury to the aorta or great vessels resulting from blunt or penetrating trauma.
  • Aortic Transection Complete or partial transection of the aorta necessitating surgical intervention.
  • Rupture Rupture of the aorta or great vessels requiring immediate repair to prevent life-threatening hemorrhage.
  • Tear or Laceration Presence of tears or lacerations in the aorta or great vessels that compromise vascular integrity.

2. Procedure

The procedure involves several critical steps to ensure successful graft insertion and repair of the aorta or great vessels:

  • Thoracotomy A thoracotomy is performed to access the chest cavity and expose the injured blood vessels. This surgical approach allows for direct visualization and manipulation of the aorta and surrounding structures.
  • Exposure of the Aorta The pleura is incised, and the left superior pulmonary vein is isolated. The phrenic nerves are identified, mobilized, and protected to prevent postoperative complications. The anterior surface of the aorta is then exposed, and the innominate, left common carotid, and left subclavian arteries are identified for reference during the repair.
  • Control of Hemorrhage To manage potential bleeding, umbilical tape is placed around the area proximal and distal to the injury. This technique helps control hemorrhage during the dissection and repair process.
  • Dissection Tissue adherent to the inferior surface of the aorta is carefully divided. The aortic arch is separated from the pulmonary artery, left common carotid, and left subclavian arteries using both blunt and sharp dissection techniques.
  • Initiation of Bypass At this stage, the aorta may be cross-clamped, or shunt bypass or cardiopulmonary bypass may be initiated to maintain distal perfusion while the injury is repaired.
  • Full Exposure The mediastinal pleura is opened to fully expose the aorta, allowing for a clear view of the injury site.
  • Graft Repair The aortic injury is repaired using a synthetic graft. The proximal anastomosis of the graft is performed first, where a clamp is placed on the graft below the anastomosis site. The proximal clamp is then released, and the integrity of the anastomosis is evaluated for any leaks, which are reinforced with additional sutures as necessary.
  • Distal Anastomosis The distal anastomosis of the graft is performed in a similar manner, ensuring a secure connection to restore blood flow.
  • Repair of Other Great Vessels If injuries to other great vessels are present, they are repaired using similar dissection and graft repair techniques.
  • Termination of Bypass Following the successful graft repair, shunt or cardiopulmonary bypass is terminated if utilized during the procedure.
  • Closure Chest tubes are placed as needed to facilitate drainage, and the chest incision is then closed to complete the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as bleeding or infection. The placement of chest tubes is essential for managing any fluid accumulation in the thoracic cavity. Patients may require close observation in a critical care setting, especially if cardiopulmonary bypass was utilized. Recovery will depend on the extent of the injury and the patient's overall health status. Follow-up imaging may be necessary to assess the integrity of the graft and ensure proper healing of the aorta or great vessels.
Short Descr INSERT MAJOR VESSEL GRAFT
Medium Descr INSJ GRAFT AORTA/GREAT VESSEL W/SHUN
Long Descr Insertion of graft, aorta or great vessels; with shunt bypass
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) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 9 - 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 Not applicable/unspecified.
CCS Clinical Classification 56 - Other vascular bypass and shunt, not heart
Date
Action
Notes
2015-01-01 Deleted Code deleted
1995-01-01 Added First appearance in code book in 1995.
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