CPT® Code 35536

A splenorenal 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 operation involves several critical steps, beginning with an incision in the abdomen to access the necessary anatomical structures. The omentum, a fold of peritoneum extending from the stomach, is carefully separated from the transverse colon to provide a clear view of the celiac axis, which includes vital arteries such as the hepatic, left gastric, and splenic arteries. During the procedure, the splenic artery is isolated, and the descending duodenum is mobilized to facilitate access to the inferior vena cava and renal vein. The inferior vena cava, a major vein that carries deoxygenated blood from the lower body to the heart, is also mobilized, and the renal artery is isolated to prepare for the grafting process. 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 surrounding soft tissue, and ligating and dividing any branches of the vein. Once the appropriate segment of the saphenous vein is removed, vascular clamps are applied to the splenic artery, and an incision is made to facilitate the attachment of the vein graft. The vein graft is then sutured in an end-to-side configuration to the splenic artery, allowing blood to flow into the graft. Subsequently, the renal artery is clamped and incised, and the vein graft is anastomosed in an end-to-side manner, effectively bypassing the obstructed area of the renal artery. After the clamps are released, the blood flow through the graft is verified using Doppler ultrasound, ensuring that the procedure has successfully restored circulation to the kidney.