CPT® Code 35535

A hepatorenal vein bypass graft is a surgical procedure designed to create a new pathway for blood flow around a diseased or obstructed segment of the renal artery, which supplies blood to the kidney. This procedure is essential for restoring adequate blood circulation to the kidney, thereby preventing potential damage due to ischemia. The surgery involves making an incision in the abdomen to access the necessary anatomical structures. During the operation, the omentum, a fold of peritoneum extending from the stomach, is separated from the transverse colon to expose the celiac axis, which includes critical arteries such as the hepatic, left gastric, and splenic arteries. The common hepatic artery is then isolated to facilitate the grafting process. The descending duodenum is mobilized to provide better access to the inferior vena cava and renal vein, which are crucial for the procedure. The inferior vena cava is carefully mobilized, and the renal artery is isolated to prepare for the grafting. A vein graft, typically harvested from the saphenous vein in the leg, is prepared for use. The harvesting process involves making an incision over the selected section of the saphenous vein, dissecting the soft tissue, and ligating the vein's branches before removing the vein segment. Once the graft is ready, vascular clamps are applied to the hepatic artery, which is then incised. The vein graft is sutured in an end-to-side configuration to the hepatic artery, establishing a new route for blood flow. Following this, the renal artery is clamped and incised, and the vein graft is anastomosed in an end-to-side manner to bypass the obstructed area of the renal artery. After ensuring proper placement, the clamps are released, and the blood flow through the graft is verified using Doppler ultrasound, confirming the success of the procedure in restoring blood supply to the kidney.