CPT® Code 35492

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1. Indications

The procedure described by CPT® Code 35492 is indicated for patients who present with significant occlusion or stenosis of the iliac artery, which may lead to symptoms such as claudication, limb ischemia, or other vascular complications. The following conditions may warrant the performance of this procedure:

• Peripheral Artery Disease (PAD) - A condition characterized by narrowed arteries reducing blood flow to the limbs, often leading to pain and mobility issues.
• Severe Atherosclerosis - The buildup of plaque in the arteries, which can cause blockages and impede blood flow.
• Intermittent Claudication - Pain or cramping in the legs or buttocks during physical activities, which is relieved by rest.
• Critical Limb Ischemia - A severe obstruction of blood flow to the extremities, which can lead to pain at rest, ulcers, or gangrene.

2. Procedure

The procedure for CPT® Code 35492 involves several critical steps to ensure effective removal of plaque from the iliac artery:

• 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 from the access artery into the occluded iliac artery. This guidewire serves as a pathway for the subsequent catheter.
• Step 3: Catheter Advancement - An atherectomy catheter is then advanced over the guidewire into the occluded segment of the artery. Once the catheter is in place, the guidewire is withdrawn, leaving the atherectomy catheter positioned for the procedure.
• Step 4: Atherectomy Procedure - The atherectomy catheter is equipped with a specialized cutting piston that is advanced through a window on one side of the catheter. As the catheter is moved along the arterial wall, the cutting piston shaves off plaque, which is then pushed into the nose of the device for removal.
• Step 5: Multiple Passes - The physician may perform several passes with the atherectomy device to ensure that sufficient plaque is removed and the artery is adequately cleared.
• Step 6: Completion Angiography - After the atherectomy is completed, the atherectomy device is exchanged for an angiography catheter. Contrast material is injected through this catheter, and a completion angiography is performed to visualize the artery and confirm that it is patent.
• 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 a pressure dressing helps to minimize these risks. Patients may be advised to rest and avoid strenuous activities for a specified period to facilitate recovery. Follow-up appointments may be scheduled to assess the success of the procedure and monitor for any recurrence of symptoms. It is essential for patients to adhere to any prescribed medication regimens, such as antiplatelet therapy, to prevent future vascular events.