CPT® Code 35491

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1. Indications

The procedure described by CPT® Code 35491 is indicated for patients who have significant arterial occlusions in the aorta that may lead to compromised blood flow. The following conditions may warrant the performance of this procedure:

• Aortic Occlusion The presence of plaque buildup in the aorta that restricts blood flow, potentially leading to ischemia or other complications.
• Peripheral Artery Disease Patients suffering from peripheral artery disease may require this procedure to alleviate symptoms and restore adequate blood circulation.
• Renal or Visceral Artery Compromise Conditions affecting the renal or visceral arteries that may necessitate intervention to prevent organ damage due to insufficient blood supply.

2. Procedure

The procedure for CPT® Code 35491 involves several critical steps to ensure effective removal of arterial plaque. Each step is detailed as follows:

• Step 1: Preparation and Access The physician begins by preparing the skin over the access artery, typically one of the femoral arteries. This preparation includes cleaning the area to reduce the risk of infection. A needle is then used to puncture the artery, and a sheath is placed to facilitate access to the vascular system.
• Step 2: Guidewire Insertion Following the placement of the sheath, a guidewire is inserted through the sheath and advanced into the occluded artery or aorta. This guidewire serves as a pathway for the subsequent devices used in the procedure.
• Step 3: Atherectomy Catheter Advancement An atherectomy catheter is then advanced over the guidewire. The guidewire is subsequently withdrawn, leaving the atherectomy catheter in place for the next phase of the procedure.
• Step 4: Plaque Removal The atherectomy device, equipped with a specialized balloon catheter that has a cutting piston, is utilized to shave plaque from the arterial wall. As the cutting piston advances, it removes the plaque, which is then collected in the nose of the atherectomy device.
• Step 5: Multiple Passes The physician may perform several passes with the atherectomy device to ensure that sufficient plaque is removed and the arterial lumen is adequately cleared.
• Step 6: Completion Angiography After the atherectomy, the device is exchanged for a guidewire, and an angiography catheter is advanced over the guidewire. The guidewire is then withdrawn, and contrast material is injected to visualize the artery. A completion angiography is performed to confirm that the renal or visceral artery or aorta is patent and that blood flow has been restored.
• Step 7: Post-Procedure Care Once the angiography is completed, the angiography catheter is withdrawn. The physician applies pressure to the arterial puncture site to control any bleeding and subsequently applies a pressure dressing to promote healing.

3. Post-Procedure

After the completion of the atherectomy procedure, patients are typically monitored for any signs of complications, such as bleeding or hematoma formation at the puncture site. The application of pressure and a dressing helps to minimize these risks. Patients may be advised on activity restrictions and follow-up appointments to assess recovery and ensure that the arterial patency is maintained. It is essential for healthcare providers to provide clear instructions regarding post-procedure care to facilitate optimal healing and recovery.