CPT® Code 35306

Add-On Code

Thromboendarterectomy, including patch graft, if performed; each additional tibial or peroneal artery (List separately in addition to code for primary procedure)

The procedure described by CPT® Code 35306 is a thromboendarterectomy, which is a surgical intervention aimed at removing a thrombus, or blood clot, as well as atherosclerotic plaque that may be adhering to the walls of an occluded artery. This procedure specifically targets the tibial or peroneal arteries, which are critical for 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. Access to these arteries is typically achieved through a surgical incision located approximately 2 cm posterior to the tibia. During the procedure, the surgeon divides the soleus muscle fibers that originate on the tibia to gain access to the posterior tibial artery, which is situated 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 located just medial to the fibula. Once the thrombosed section of the artery is isolated, clamps are applied both proximally and distally to the area of interest. An incision is then made into the blood vessel, allowing for the removal of plaque and any blood clot debris. The procedure 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 edges of the normal intima remain securely attached to the vessel walls after the obstruction has been removed, sutures are placed. In some cases, a patch graft may be utilized to repair the artery; 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 closed, the clamps are removed, and the surgical incision is repaired. It is important to note that CPT® Code 35306 is used to report each additional tibial or peroneal artery treated during the procedure, following the initial artery, which is reported with CPT® Code 35305.