CPT® Code 33987

Add-On Code

Arterial exposure with creation of graft conduit (eg, chimney graft) to facilitate arterial perfusion for ECMO/ECLS (List separately in addition to code for primary procedure)

The procedure described by CPT® Code 33987 involves the creation of a graft conduit, such as a chimney graft, to enhance arterial perfusion in patients undergoing Extracorporeal Membrane Oxygenation (ECMO) or Extracorporeal Life Support (ECLS). This intervention is particularly crucial when the arterial vessels are small or when there is a risk of limb ischemia due to cannulation. The graft conduit serves to facilitate both antegrade and retrograde blood flow by deploying a covered stent parallel to the ECMO/ECLS cannulae, typically within the femoral or axillary vessels. The design of the stent allows it to extend proximally, thereby preserving blood flow to the side branches of the main arterial vessel, which is essential for maintaining adequate perfusion to the surrounding tissues. The graft conduit can be implemented either as a planned procedure during the initial placement of the ECMO/ECLS cannulae or as a rescue intervention to salvage side branches that may be compromised later in the course of therapy. The insertion of the graft conduit generally necessitates an open technique, often referred to as a cut down, to gain access to the vessel. Confirmation of the proper placement of the graft conduit or stent is typically achieved through imaging techniques such as fluoroscopy or transesophageal echocardiography (TEE), ensuring that the procedure is performed accurately and effectively.