CPT® Code 34716

Add-On Code

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

The procedure described by CPT® Code 34716 involves the surgical exposure of the axillary or subclavian artery, which is a critical blood vessel located beneath the clavicle. This exposure is achieved through an incision made either infraclavicularly (below the clavicle) or supraclavicularly (above the clavicle). The primary purpose of this procedure is to create a conduit, which serves as a pathway for the delivery of an endovascular prosthesis or to establish cardiopulmonary bypass. A conduit may be necessary when direct cannulation of the artery is not advisable due to various clinical considerations. During the procedure, the surgeon carefully incises the skin and dissects through the surrounding tissues to access the artery while taking precautions to protect adjacent veins and nerves. The dissection involves controlling any bleeding that may occur, typically through ligation or the use of electrocautery. The axillary or subclavian artery is meticulously freed from surrounding tissues over a length of approximately 5 to 6 centimeters and is secured with vessel loops to maintain its position. Once adequately exposed, the artery is clamped and incised to facilitate the creation of the conduit. The conduit itself is selected based on the specific requirements of the procedure and is tailored to fit appropriately before being anastomosed (surgically connected) to the axillary or subclavian artery. After the conduit is clamped, the initial clamps are removed, and any vascular leaks at the anastomosis site are reinforced with sutures to ensure a secure connection. If the conduit is intended for cardiopulmonary bypass, it is sewn to the artery following heparinization, and an arterial cannula is connected to facilitate the bypass. A venous cannula may also be placed to assist in the bypass process. Upon completion of the procedure, the graft conduit may either remain in place with its distal end anastomosed to the artery or be cut short, with the stump closed using sutures. It is important to note that this procedure is reported separately and is unilateral, meaning it is performed on one side of the body, and should be listed in addition to the code for the primary procedure when applicable.