CPT® Code 35305

This procedure, known as thromboendarterectomy, is a surgical intervention aimed at removing a thrombus, which can be a blood clot or atherosclerotic plaque that adheres to the walls of an artery. The focus of this specific procedure is on the tibial or peroneal artery, which are critical vessels supplying blood to the lower leg. The peroneal artery, also referred to as the fibular artery, branches from the tibioperoneal trunk alongside the posterior tibial artery. Accessing these arteries typically involves making an incision approximately 2 cm posterior to the tibia. During the procedure, the surgeon divides the soleus muscle fibers that originate on the tibia to reach the posterior tibial artery, which is located in the deep posterior compartment, resting on the surface of the tibialis posterior muscle. To expose the peroneal artery, the surgeon retracts the posterior tibial vessels and continues laterally towards the flexor hallucis longus muscle, which is situated just medial to the fibula. Once the thrombosed section of the artery is identified, it is carefully isolated and dissected from surrounding structures. Clamps are then applied both proximally and distally to the affected area. An incision is made into the artery, allowing for the removal of plaque and blood clot debris. This process involves separating the vessel lining from the arterial walls, which increases the luminal diameter of the artery, thereby improving blood flow. To ensure that the artery maintains its integrity after the obstruction and vessel intima have been excised, sutures are used to secure the edges of the normal intima to the vessel walls. In some cases, a patch graft may be utilized to repair the artery; this graft can be harvested from the patient, sourced from a donor, or constructed from synthetic materials. Once the vessel is closed, the clamps are removed, and the surgical incision is subsequently repaired. It is important to code this procedure using CPT® Code 35305 for the initial tibial or peroneal artery, and CPT® Code 35306 for each additional artery treated during the same surgical session.