CPT® Code 35131

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, iliac artery (common, hypogastric, external)

The CPT® Code 35131 refers to the surgical procedure for the direct repair of an aneurysm or pseudoaneurysm of the iliac artery, which includes the common, hypogastric, and external iliac branches. An aneurysm is characterized by an abnormal enlargement or dilation of an artery, which can occur due to various factors such as arteriosclerosis, mechanical obstruction, or malposition of the artery. Less frequently, conditions like syphilis, tuberculosis, or abnormalities in the vessel wall, such as fibromuscular dysplasia, may also lead to aneurysm formation. In contrast, a pseudoaneurysm is a hematoma that forms in direct communication with the artery wall but does not involve all three layers of the arterial wall, typically resulting from trauma or complications from medical procedures like catheterization. The procedure involves accessing the iliac artery through a lower abdominal or leg incision, followed by the division of overlying soft tissues to expose the artery. Control of the iliac artery is established both above and below the aneurysm, and anticoagulation is administered before clamping the artery. The aneurysm sac is then opened to remove any thrombus and plaque, and the artery walls are sutured. Depending on the specific case, a patch graft may be applied, or the aneurysm may be excised with direct repair through end-to-end anastomosis. Alternatively, a tube graft may be inserted, with the aneurysm sac closed over the graft. This procedure is performed electively and is distinct from the emergency repair of a ruptured aneurysm, which is coded under CPT® Code 35132, where immediate control of bleeding is critical prior to repair.