CPT® Code 35495

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1. Indications

The procedure described by CPT® Code 35495 is indicated for patients experiencing occlusions in the tibioperoneal trunk and its branches. These occlusions may result from various conditions, including but not limited to atherosclerosis, which is the buildup of plaque in the arteries, leading to reduced blood flow. The procedure is typically performed on patients who exhibit symptoms such as claudication, which is characterized by pain or cramping in the legs during physical activity due to inadequate blood supply. Other indications may include critical limb ischemia, where there is severe obstruction of blood flow, potentially leading to tissue damage or loss. The goal of the procedure is to restore adequate blood flow to the affected areas, alleviating symptoms and preventing further complications.

2. Procedure

The procedure begins with the preparation of the skin over the access artery, which is usually one of the femoral arteries. The area is cleaned and sterilized to minimize the risk of infection. A needle is then used to puncture the artery, and a sheath is placed to provide access to the arterial system. Following this, a guidewire is inserted through the sheath and advanced from the access artery into the occluded artery. This guidewire serves as a pathway for the subsequent devices used in the procedure. Once the guidewire is in place, the atherectomy catheter is advanced over the guidewire. The guidewire is then withdrawn, allowing the atherectomy device to take its place within the artery. The atherectomy device is equipped with a specialized balloon catheter that has a window on one side. A cutting piston is advanced through this window, which shaves plaque from the arterial wall as the device is maneuvered within the artery. The shaved plaque is pushed into the nose of the atherectomy device, where it is collected for removal at the end of the procedure. The physician may perform several passes with the atherectomy device to ensure that the desired level of plaque removal is achieved, thereby restoring the artery's patency. After the atherectomy is completed, the atherectomy device is exchanged for an angiography catheter. Contrast material is injected through this catheter to visualize the artery and confirm that it is patent. A completion angiography is performed to assess the success of the procedure. Once the angiography is complete, the angiography catheter is withdrawn. Finally, pressure is applied to the arterial puncture site to control any bleeding, and a pressure dressing is applied to secure the site and promote healing.

3. Post-Procedure

After the completion of the atherectomy procedure, several post-procedure care steps are essential to ensure patient safety and recovery. The physician applies pressure to the arterial puncture site to control any potential bleeding, which is a critical step in preventing hematoma formation or other complications. A pressure dressing is then applied to the site to provide support and further control bleeding while promoting healing. Patients are typically monitored for any signs of complications, such as excessive bleeding, infection, or changes in limb perfusion. Depending on the patient's condition and the extent of the procedure, they may be advised to limit physical activity for a specified period to allow for proper healing. Follow-up appointments are often scheduled to assess the success of the procedure and to monitor the patient's recovery. During these follow-ups, the physician may perform additional imaging studies to ensure that the artery remains patent and that blood flow is adequately restored.