CPT® Code 35132

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, iliac artery (common, hypogastric, external)

The CPT® Code 35132 refers to the surgical procedure for the direct repair of a ruptured 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 contribute to the formation of an aneurysm. In contrast, a pseudoaneurysm is a hematoma that forms in 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 and/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 prior to clamping the artery. The aneurysm sac is then opened to remove any thrombus and plaque, and the artery walls are repaired with sutures. Depending on the specific circumstances, a patch graft may be applied, or the aneurysm may be excised with direct repair through end-to-end anastomosis of the vessel ends. Alternatively, a tube graft may be inserted, which involves making a longitudinal incision in the artery and suturing the graft to healthy artery segments. This procedure is classified as an emergency intervention due to the nature of the ruptured aneurysm, necessitating immediate control of bleeding before repair can be performed.