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Official Description

Thromboendarterectomy, including patch graft, if performed; combined aortoiliofemoral

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Thromboendarterectomy is a surgical procedure aimed at removing thrombi, which are blood clots or atherosclerotic plaques, from occluded arteries. Specifically, CPT® Code 35363 refers to a combined aortoiliofemoral thromboendarterectomy, which involves the abdominal aorta, iliac artery, and femoral artery. This procedure is essential for restoring blood flow in patients with significant arterial blockages that can lead to severe complications, including ischemia or limb loss. The process begins with an incision in the abdomen to access the aorta and iliac arteries, and if necessary, an additional incision in the leg to access the femoral artery. The surgeon isolates the affected segments of the blood vessels, carefully dissects them from surrounding tissues, and removes the obstructive material along with the inner lining of the artery (intima) to enhance the vessel's diameter. This meticulous approach not only alleviates the blockage but also aims to restore normal blood flow, thereby improving the patient's overall vascular health. The procedure may involve the use of temporary shunts to maintain perfusion during surgery and may conclude with the application of sutures or grafts to repair the arteries, ensuring that blood flow is reestablished effectively.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The thromboendarterectomy procedure, specifically CPT® Code 35363, is indicated for patients presenting with significant arterial occlusions that may lead to critical ischemia or other vascular complications. The following conditions may warrant this surgical intervention:

  • Severe Atherosclerosis - The presence of substantial plaque buildup in the abdominal aorta, iliac, and femoral arteries that restricts blood flow.
  • Thrombosis - The formation of blood clots within the arteries that obstruct normal blood circulation.
  • Peripheral Artery Disease (PAD) - A condition characterized by narrowed arteries, reducing blood flow to the limbs, which may necessitate surgical intervention to restore adequate perfusion.
  • Ischemic Symptoms - Patients exhibiting symptoms such as claudication, pain, or weakness in the legs due to insufficient blood supply may require this procedure.

2. Procedure

The thromboendarterectomy procedure involves several critical steps to ensure the effective removal of occlusions and restoration of blood flow. The following outlines the procedural steps involved:

  • Step 1: Incision and Exposure - The procedure begins with a surgical incision in the abdomen to access the abdominal aorta and iliac arteries. If a combined aortoiliofemoral thromboendarterectomy is indicated, an additional incision is made in the leg to expose the femoral artery.
  • Step 2: Isolation and Dissection - The surgeon carefully isolates the thrombosed segments of the affected blood vessels, ensuring that they are dissected away from adjacent structures to prevent damage to surrounding tissues.
  • Step 3: Maintenance of Perfusion - To maintain blood flow during the procedure, a temporary shunt may be placed, allowing perfusion to continue while the obstructed areas are addressed.
  • Step 4: Clamping and Incision - Vascular clamps are applied proximal to the obstructed portion of the aorta and distal to the iliac or femoral artery. The affected portions of the blood vessels are then incised to facilitate the removal of plaque and blood clot debris.
  • Step 5: Removal of Intima - The artery lining, known as the intima, is separated from the walls of the aorta, iliac, and femoral arteries and removed. This step is crucial for increasing the diameter of the blood vessel and improving blood flow.
  • Step 6: Repair of Blood Vessels - The edges of the remaining normal intima are sutured to the blood vessel walls. The aorta, iliac, and femoral arteries are then repaired primarily with sutures, or a venous or synthetic patch graft may be applied to enlarge the diameter of the blood vessels.
  • Step 7: Removal of Shunt and Clamps - If a shunt was placed, it is removed at this stage. The vascular clamps are then taken off, allowing blood flow to resume through the previously obstructed vessels.
  • Step 8: Hemostasis Check - The suture lines of the aorta, iliac, and femoral arteries are checked for hemostasis to ensure there is no bleeding at the surgical site.
  • Step 9: Closure of Tissues - Finally, the overlying tissues are closed in layers to complete the procedure, ensuring proper healing and recovery.

3. Post-Procedure

After the thromboendarterectomy procedure, patients are typically monitored for any signs of complications, such as bleeding or infection. Recovery may involve a hospital stay where vital signs are closely observed, and pain management is provided. Patients may be advised on activity restrictions and follow-up appointments to assess the success of the procedure and monitor for any recurrence of symptoms. Rehabilitation may also be recommended to improve circulation and overall vascular health. It is essential for patients to adhere to prescribed medications and lifestyle modifications to support recovery and prevent future vascular issues.

Short Descr RECHANNELING OF ARTERY
Medium Descr TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL
Long Descr Thromboendarterectomy, including patch graft, if performed; combined aortoiliofemoral
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2F - Major procedure, cardiovascular-Other
MUE 1
CCS Clinical Classification 60 - Embolectomy and endarterectomy of lower limbs
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
2007-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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