CPT® Code 35390

Add-On Code

Reoperation, carotid, thromboendarterectomy, more than 1 month after original operation (List separately in addition to code for primary procedure)

A reoperation for carotid thromboendarterectomy is a surgical procedure performed on the carotid artery more than one month after the initial operation. This intervention is necessary when there is a recurrence of occlusion due to thrombus formation, which may include blood clots or atherosclerotic plaque that has re-adhered to the arterial walls. The procedure aims to restore normal blood flow by removing these obstructions and the inner lining of the artery, known as the intima, which can become thickened or damaged. The surgery involves making an incision in the neck to access the carotid artery, isolating the affected segment, and carefully dissecting it from surrounding tissues. To ensure that blood flow to the brain is maintained during the operation, a temporary shunt may be placed. The surgical team will then clamp the artery above and below the blockage, incise the artery, and meticulously remove the plaque and clot debris. Following this, the intima is separated from the arterial wall and excised to enhance the artery's diameter. The remaining healthy intima is sutured back to the vessel walls, and the artery is reconstructed either with sutures alone or with a patch graft made from either venous tissue or synthetic material to further enlarge the artery's diameter. After the procedure, if a shunt was used, it is removed, and blood flow is restored by releasing the clamps. The surgical site is then checked for any bleeding before the layers of tissue are closed. This detailed approach ensures that the carotid artery is effectively cleared of obstructions, thereby reducing the risk of stroke and improving cerebral perfusion.