CPT® Code 35523

A bypass graft procedure, specifically coded as CPT® 35523, involves the surgical replacement of a stenotic or occluded segment of an artery in the arm, extending from the brachial artery to either the ulnar or radial artery, using a venous graft. This procedure is typically indicated for patients suffering from chronic arterial occlusive disease and ischemia of the upper extremity, conditions that may arise due to factors such as immunosuppression or renal failure. The surgical approach begins with an incision in the upper arm to access the brachial artery, followed by careful dissection of the surrounding soft tissue to expose the artery adequately. Rubber loops are then placed around the artery to isolate it, facilitating the subsequent steps of the procedure. The surgeon then proceeds to the lower arm, making an incision over the ulnar or radial artery, usually at the wrist, to expose the selected artery for grafting. A segment of saphenous vein is harvested from the leg to serve as the bypass graft. The procedure culminates with the suturing of the venous graft to the brachial artery and the selected ulnar or radial artery, ensuring proper blood flow and patency through careful verification techniques such as Doppler ultrasound and palpation of distal pulses.