CPT® Code 35311

Thromboendarterectomy is a surgical procedure specifically targeting the subclavian or innominate artery, which is accessed through a thoracic incision. This operation is primarily indicated for the removal of a thrombus, which can be a blood clot or atherosclerotic plaque that has formed and adhered to the inner walls of the artery, leading to occlusion. The procedure involves making an incision in the chest to gain access to the affected artery. Once accessed, the thrombus is carefully isolated and dissected from surrounding structures to prevent damage to adjacent tissues. To maintain blood flow during the procedure, a temporary shunt may be placed. The surgical team will then apply clamps to the artery both above (proximal) and below (distal) the area of obstruction. An incision is made in the artery, allowing for the removal of the thrombus and any plaque or debris that may be present. The inner lining of the artery, known as the intima, is also removed to enhance the diameter of the artery, facilitating better blood flow. After the removal of the obstructive material, the edges of the remaining healthy intima are sutured back to the arterial walls. The artery is then repaired, either through primary suturing or by using a patch graft, which can be made from venous tissue or synthetic material, to further enlarge the artery's diameter. If a shunt was utilized, it is removed at this stage, and the vascular clamps are taken off to restore blood flow through the artery. Finally, the surgical team checks the suture line for any signs of bleeding (hemostasis) before closing the overlying tissues in layers to complete the procedure.