CPT® Code 35321

Thromboendarterectomy is a surgical procedure specifically targeting the axillary-brachial artery, which is a major blood vessel in the arm. This operation is primarily performed to remove a thrombus, which can be a blood clot or a buildup of atherosclerotic plaque that has adhered to the inner walls of the artery, leading to occlusion or blockage. The procedure involves making an access incision in the arm directly over the affected artery to gain access to the thrombosed area. Once the artery is accessed, the surgeon isolates the affected segment and carefully dissects it away from surrounding structures to prevent damage to adjacent tissues. To maintain blood flow during the procedure, a temporary shunt may be placed. This allows for perfusion while the obstructed portion of the artery is being treated. The surgical process includes placing clamps both proximal and distal to the obstruction, incising the artery, and meticulously removing the plaque and any blood clot debris. The intima, which is the inner lining of the artery, is also removed to enhance the diameter of the artery, facilitating better blood flow. After the removal of the thrombus and intima, the surgeon sutures the edges of the remaining normal intima to the arterial walls. The artery is then repaired, either through primary suturing or by applying a patch graft, which can be either venous or synthetic, to further enlarge the artery's diameter. If a shunt was utilized, it is removed before the vascular clamps are taken off, allowing blood flow to resume through the artery. Finally, the surgical site is checked for hemostasis, and the overlying tissues are closed in layers to ensure proper healing.