CPT® Code 35506

A bypass graft procedure involving the carotid-subclavian or subclavian-carotid arteries is performed to create an alternative pathway for blood flow around a diseased or obstructed segment of the artery. This surgical intervention utilizes a vein, typically harvested from the patient's leg, to form a graft that connects the carotid artery to the subclavian artery or vice versa. The procedure begins with a supraclavicular incision, which allows the surgeon to access the subclavian artery. During the operation, the scalene fat pad is carefully dissected, and the anterior scalene muscle is divided to facilitate exposure of the arteries. The surgeon then controls blood flow by placing rubber loops around the arteries at the planned incision sites. A vein graft, often a saphenous vein, is harvested from the leg, which involves making an incision over the vein, dissecting the surrounding soft tissue, and ligating any branches before removing the vein segment. Once the graft is prepared, the subclavian artery is clamped and incised, and the vein graft is sutured in place. The carotid artery is also incised or a window is created to attach the graft. After ensuring proper placement, the vascular clamps are removed, and blood flow through the graft is verified using Doppler ultrasound, along with an evaluation of distal pulses to confirm the success of the bypass graft.