CPT® Code 35151

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, popliteal artery

The CPT® Code 35151 refers to the surgical procedure for the direct repair of an aneurysm or pseudoaneurysm of the popliteal artery, 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 aneurysm is defined as 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, aneurysms may arise from conditions like syphilis, tuberculosis, or abnormalities in the vessel wall, such as fibromuscular dysplasia. In contrast, a pseudoaneurysm is characterized by not involving all three layers of the artery wall and is often the result of trauma—either blunt or penetrating—or complications from medical procedures, such as catheterization. This condition leads to the formation of a pulsating hematoma that is encapsulated and communicates directly with the artery wall. The popliteal artery, which is a continuation of the common femoral artery, begins at the popliteal space behind the knee and bifurcates into the anterior and posterior tibial arteries. During the procedure, a surgical incision is made in the leg to access the popliteal artery, followed by the division of overlying soft tissues to expose the artery. Control of the popliteal artery is established both above and below the aneurysm, and after administering anticoagulants, the artery is clamped to facilitate the repair. The aneurysm sac is then opened to remove any thrombus and plaque, and the artery walls are sutured. Depending on the specific case, a graft may be applied, which can be either an autogenous graft (using the saphenous vein) or a synthetic patch graft. Alternatively, the aneurysm may be excised with direct repair through end-to-end anastomosis or by placing a tube graft. This procedure is performed in a nonemergent, elective setting, distinguishing it from the emergency procedure described by CPT® Code 35152, which pertains to the repair of a ruptured aneurysm.