CPT® Code 35482

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1. Indications

The procedure described by CPT® Code 35482 is indicated for patients experiencing significant arterial occlusion in the iliac artery, which may lead to symptoms such as claudication, limb ischemia, or other complications associated with peripheral artery disease. The primary goal of this procedure is to restore adequate blood flow to the affected area, alleviating symptoms and preventing further vascular complications.

• Claudication Pain or cramping in the legs or buttocks during physical activity due to inadequate blood flow.
• Limb Ischemia Insufficient blood supply to the limbs, which can lead to pain, ulcers, or tissue necrosis.
• Peripheral Artery Disease (PAD) A condition characterized by narrowed arteries reducing blood flow to the limbs, often leading to severe complications if untreated.

2. Procedure

The procedure begins with the physician preparing the skin over the access artery, typically the femoral artery, and making an incision to expose the artery. This initial step is crucial for gaining access to the vascular system. Following the incision, the artery is carefully exposed, and a small nick is made in the artery to facilitate the placement of a sheath. The sheath serves as a conduit for the subsequent instruments used in the procedure.

• Step 1: The physician makes an incision in the skin over the access artery and exposes the artery.
• Step 2: A nick is made in the artery, and a sheath is inserted to allow for the introduction of other devices.
• Step 3: A guidewire is inserted through the sheath and advanced from the access artery to the occluded iliac artery.
• Step 4: An atherectomy catheter is then advanced over the guidewire, and the guidewire is withdrawn, allowing the catheter to operate directly on the arterial blockage.
• Step 5: The atherectomy catheter, equipped with a cutting piston, is used to shave plaque from the arterial wall. The cutting piston advances through a window on the catheter, effectively removing the plaque.
• Step 6: As the plaque is shaved off, it is collected in the nose of the atherectomy device, which is designed to capture the debris for removal.
• Step 7: The physician may perform multiple passes with the atherectomy device to ensure thorough removal of the plaque and achieve optimal results.
• Step 8: After the atherectomy is completed, the atherectomy device is exchanged for a guidewire, which is then used to facilitate the next step.
• Step 9: An angiography catheter is advanced over the guidewire, and the guidewire is withdrawn to prepare for imaging.
• Step 10: Contrast material is injected through the angiography catheter, and completion angiography is performed to assess the patency of the vessel and ensure that the procedure was successful.
• Step 11: Finally, the angiography catheter is withdrawn, the access artery is repaired, and the skin incision is closed, concluding the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications that may arise from the intervention. Patients are typically observed for signs of bleeding or hematoma at the access site. Additionally, the physician may provide instructions regarding activity restrictions and follow-up appointments to assess recovery and the success of the procedure. Patients may also be advised on lifestyle modifications and medications to manage underlying conditions such as peripheral artery disease. The expected recovery time can vary based on individual patient factors and the extent of the procedure performed.