CPT® Code 34714

Add-On Code

Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure)

The procedure described by CPT® Code 34714 involves the surgical exposure of the femoral artery through a groin incision, with the primary purpose of creating a conduit. This conduit serves two main functions: it facilitates the delivery of an endovascular prosthesis or establishes a pathway for cardiopulmonary bypass. The term "conduit" refers to a channel or passage that allows for the movement of blood or other fluids, particularly when direct access to the artery is not advisable due to various clinical considerations. The procedure begins with an incision in the skin over the groin area, followed by careful dissection of the subcutaneous tissue to reach the common femoral artery. During this dissection, it is crucial to protect surrounding structures, including the femoral nerve and vein, to prevent complications. The common femoral artery, along with its branches—the superficial and deep femoral arteries—are meticulously freed from surrounding tissue and secured with vessel loops for better visibility and access. In some cases, the distal external iliac artery may also be dissected, which may necessitate the retraction or division of the inguinal ligament. Once the artery is adequately exposed, small branch arteries are ligated or cauterized to minimize bleeding. The femoral artery is then clamped and incised to allow for the tailored selection and anastomosis of the conduit. This conduit is clamped, and the previously placed clamps on the femoral artery are removed, ensuring that any vascular leaks at the anastomosis site are reinforced with sutures. If the conduit is intended for cardiopulmonary bypass, it is sewn to the femoral artery after the administration of heparin, followed by the connection to an arterial cannula. A venous cannula may also be placed to establish cardiopulmonary bypass. After the procedure is completed, the graft conduit may either remain in place with the distal end anastomosed to the femoral artery or be cut short with the stump closed using sutures. It is important to note that if the procedure involves puncturing the groin for percutaneous access to the femoral artery, this is reported separately under CPT® Code 34713.