CPT® Code 35304

The procedure described by CPT® Code 35304 is known as thromboendarterectomy, specifically targeting the tibioperoneal trunk artery. This surgical intervention is performed to remove a thrombus, which can be a blood clot or atherosclerotic plaque that has adhered to the walls of the blood vessel, leading to occlusion. The tibioperoneal trunk artery is a critical vessel located in the upper part of the lower leg, serving as the continuation of the terminal popliteal artery. From this trunk, both the fibular and posterior tibial arteries branch off, supplying blood to the lower leg and foot. The procedure involves making an access incision that extends from the standard incision used to expose the popliteal artery, allowing the surgeon to reach the affected area effectively. During the operation, the medial head of the gastrocnemius muscle and the popliteal vein are carefully retracted to provide a clear view and access to the tibioperoneal trunk. The soleus muscle, which is located on the tibia, is divided to facilitate access to the trunk. The thrombus is then isolated and meticulously dissected from surrounding structures. Clamps are applied both proximally and distally to control blood flow, allowing for a safe incision into the blood vessel. The removal of plaque and blood clot debris is crucial for restoring normal blood flow. The procedure also involves separating the vessel lining from the arterial walls, which increases the luminal diameter of the artery, thereby improving blood circulation. To ensure that the edges of the normal intima remain securely attached to the vessel walls, sutures are placed to prevent separation when blood flow resumes. In some cases, after the obstruction and vessel intima are excised, a patch graft may be utilized for repair. This graft can be harvested from the patient or obtained from a donor, or it may be made from synthetic materials. Once the vessel is successfully closed, the clamps are removed, and the incision is repaired, completing the procedure.