CPT® Code 35082

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta

The CPT® Code 35082 refers to the surgical procedure for the direct repair of a ruptured abdominal aortic aneurysm or pseudoaneurysm, which may also involve excision (either partial or total) and the insertion of a graft, with or without the use of a patch graft. An abdominal aortic aneurysm is characterized by an abnormal enlargement or dilation of the abdominal aorta, which can lead to serious complications if not addressed promptly. The causes of such aneurysms can include arteriosclerosis, mechanical obstructions like thoracic outlet syndrome, or malposition of the artery. Less frequently, conditions such as syphilis, tuberculosis, or abnormalities in the vessel wall, such as fibromuscular dysplasia, may contribute to the formation of an aneurysm. A pseudoaneurysm, in contrast to a true aneurysm, does not involve all three layers of the arterial wall and is often 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 abdominal aorta, which is a continuation of the thoracic aorta, runs through the abdominal cavity and bifurcates into the iliac arteries, supplying blood to the lower body. During the procedure, a midline abdominal, transverse, or retroperitoneal flank incision is made to access the abdominal aorta. The surgical team carefully divides the overlying soft tissues and dissects the duodenum away from the aorta to expose it fully. Proximal control is established below the renal arteries, and distal control is achieved above the iliac arteries. Following the administration of diuretics and anticoagulants, the iliac arteries and proximal aorta are clamped to prevent blood loss. The aneurysm sac is then opened longitudinally, allowing for the removal of any thrombus and plaque. The lumbar arteries and inferior mesenteric artery are oversewn to facilitate the repair. A synthetic tube graft or conduit is then sutured to the healthy aorta both distal and proximal to the aneurysm site. After the graft is placed, the aneurysm sac is closed over it, clamps are released, and normal blood flow is restored. Finally, the retroperitoneum is repaired, and the abdominal incision is closed. This procedure is classified as an emergency intervention due to the critical nature of a ruptured aneurysm, necessitating immediate action to control bleeding before the repair can be performed.