CPT® Code 35518

1. Indications

The axillary-axillary bypass graft procedure is indicated for patients experiencing significant vascular obstruction or disease affecting the axillary artery, which may lead to compromised blood flow to the upper extremities. The following conditions may warrant this surgical intervention:

• Arterial Occlusion - Presence of a blockage in the axillary artery that impedes blood flow.
• Peripheral Artery Disease - A condition characterized by narrowed arteries reducing blood flow to the limbs.
• Trauma - Injury to the axillary artery that results in compromised blood circulation.
• Aneurysm - Abnormal dilation of the axillary artery that may require bypass to restore normal blood flow.

2. Procedure

The axillary-axillary bypass graft procedure involves several critical steps to ensure successful grafting and restoration of blood flow. The following outlines the procedural steps:

• Step 1: Incision and Exposure - A skin incision is made in the chest just below the clavicle to access the axillary artery. The surgeon carefully dissects the soft tissue to expose the proximal aspect of the first axillary artery on one side of the chest.
• Step 2: Contralateral Exposure - The same incision and dissection process is repeated on the opposite side to expose the proximal aspect of the second axillary artery, preparing both sites for grafting.
• Step 3: Tunnel Creation - A tunnel is created across the chest, connecting the two axillary arteries. This tunnel will serve as the pathway for the vein graft.
• Step 4: Vein Graft Harvesting - A vein graft is harvested, typically from the saphenous vein in the leg. An incision is made over the section of the saphenous vein to be used, and the surrounding soft tissue is dissected. The branches of the vein are ligated and divided, and the desired segment of vein is ligated proximally and distally, then removed from the leg.
• Step 5: Graft Attachment - Vascular clamps are applied to the first axillary artery, and an incision is made in the artery. The harvested vein graft is then sutured to the first axillary artery. The graft is passed through the previously created tunnel to the second axillary artery, which is also clamped and incised.
• Step 6: Final Suturing - The other end of the vein graft is sutured to the second axillary artery, completing the bypass connection.
• Step 7: Verification of Blood Flow - The vascular clamps are removed, and blood flow through the graft is checked using Doppler ultrasound. Additionally, distal pulses are evaluated to ensure the patency of the bypass graft.

3. Post-Procedure

After the axillary-axillary bypass graft procedure, patients are typically monitored for any signs of complications, such as bleeding or infection at the incision sites. Recovery may involve pain management and physical therapy to restore mobility and strength in the affected arm. Patients are advised to follow up with their healthcare provider to assess the success of the graft and ensure proper healing. Regular monitoring of blood flow and distal pulses is essential to confirm the graft's patency and functionality.