CPT® Code 35021

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, innominate, subclavian artery, by thoracic incision

The CPT® Code 35021 refers to the surgical procedure involving the direct repair of an aneurysm or pseudoaneurysm, as well as the excision (either partial or total) and graft insertion, which may include the use of a patch graft. This procedure specifically targets the innominate or subclavian artery and is performed through a thoracic incision. An aneurysm is characterized by an abnormal enlargement or dilation of an artery, which can arise from various causes such as arteriosclerosis, mechanical obstructions like thoracic outlet syndrome, or malposition of the artery. Less frequently, aneurysms may be caused by infections such as syphilis or tuberculosis, or by structural abnormalities of the vessel wall, such as fibromuscular dysplasia. In contrast, a pseudoaneurysm is a condition that does not involve all three layers of the arterial wall and is typically the result of trauma—either blunt or penetrating—or complications from medical procedures, such as catheterization. This results in a pulsating hematoma that is encapsulated and communicates directly with the artery wall. The surgical approach for this procedure may involve harvesting a saphenous vein graft from the lower leg if necessary. The operation begins with a median sternotomy, which may be extended into the supraclavicular region or neck as required. During the procedure, the left brachiocephalic vein may be divided or mobilized to gain access to the innominate or subclavian artery, which is then clamped to facilitate the repair. The aneurysm sac is opened, and any thrombus or plaque is removed before the artery walls are sutured back together, with the potential application of an autogenous or synthetic patch graft. Alternative techniques may include end-to-end anastomosis of the vessel ends or the insertion of a tube graft, which is sutured to healthy artery segments. Once the repair is complete, clamps are released to restore blood flow. It is important to note that this procedure is classified as nonemergent and elective, distinguishing it from the emergency repair of a ruptured aneurysm, which is coded differently.