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Code deleted, see 35539, 35540, 35556, 35583

Official Description

Bypass graft, with vein; aortofemoral-popliteal

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

An aortofemoral-popliteal bypass graft, designated by CPT® Code 35551, is a surgical procedure aimed at restoring blood flow in patients with significant arterial obstruction. This procedure involves the creation of a bypass route using a vein graft to circumvent blocked segments of the aorta and iliac arteries, as well as the femoral artery, ultimately connecting to the popliteal artery located behind the knee. The operation begins with an incision in the abdomen to access the aorta, followed by mobilization of the small intestine and opening of the retroperitoneum to expose the aorta. A tunnel is then created from the aorta over the iliac artery, facilitating the connection to the femoral artery through a groin incision. The procedure requires careful dissection and exposure of the arteries involved, ensuring that the graft can be properly placed. The vein graft, often harvested from the saphenous vein in the leg, is meticulously prepared and anastomosed to both the aorta and the popliteal artery. This complex surgical intervention is critical for patients suffering from peripheral vascular disease, as it aims to restore adequate blood flow to the lower extremities, thereby alleviating symptoms and preventing complications associated with poor circulation.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The aortofemoral-popliteal bypass graft procedure is indicated for patients experiencing significant arterial obstruction that impairs blood flow to the lower extremities. The following conditions may warrant this surgical intervention:

  • Peripheral Arterial Disease (PAD) - A condition characterized by narrowed arteries reducing blood flow to the limbs, often leading to pain and mobility issues.
  • Critical Limb Ischemia - A severe obstruction of the arteries that significantly reduces blood flow to the extremities, potentially resulting in pain at rest, non-healing wounds, or gangrene.
  • Claudication - Pain or cramping in the legs or buttocks during physical activities due to inadequate blood flow, which may necessitate surgical intervention when conservative treatments fail.

2. Procedure

The aortofemoral-popliteal bypass graft procedure involves several critical steps to ensure successful graft placement and restoration of blood flow:

  • Step 1: Abdominal Incision and Exposure - The procedure begins with an incision in the abdomen, allowing access to the aorta. The small intestine is mobilized to provide a clear view of the retroperitoneal space, where the aorta is carefully exposed by dissecting it free from surrounding tissues.
  • Step 2: Tunnel Creation - A tunnel is created from the aorta over the iliac artery, facilitating the connection to the femoral artery. This step is crucial for the proper placement of the vein graft.
  • Step 3: Groin Incision - A separate incision is made in the groin on the affected side to expose the femoral artery. This access point is essential for the anastomosis of the graft to the femoral artery.
  • Step 4: Popliteal Artery Exposure - The planned anastomosis site in the popliteal artery is accessed through an incision made behind the knee, allowing for the connection of the graft at this distal site.
  • Step 5: Vein Graft Harvesting - A vein graft, typically the saphenous vein, is harvested from the leg. An incision is made over the section of the vein to be used, and surrounding soft tissue is dissected away. Branches of the vein are ligated and divided, and the selected section of the vein is ligated proximally and distally, then removed.
  • Step 6: Graft Anastomosis - The vein graft is then anastomosed to the aorta. The aorta is clamped and incised to facilitate this connection. The graft is passed through the tunnel created earlier and anastomosed to the popliteal artery, which is also clamped and incised for the distal connection.
  • Step 7: Hemostasis and Flow Check - After all anastomosis sites are completed, vascular clamps are released. Hemostasis is checked at all anastomosis sites to ensure there is no bleeding. Blood flow through the graft is assessed using Doppler ultrasound, and distal pulses are evaluated to confirm the patency of the bypass graft.

3. Post-Procedure

Post-procedure care for patients undergoing an aortofemoral-popliteal bypass graft includes monitoring for complications such as bleeding, infection, or graft failure. Patients are typically observed in a recovery area before being transferred to a hospital room. Pain management is provided, and vital signs are closely monitored. Rehabilitation may be initiated to promote mobility and recovery. Follow-up appointments are essential to assess the graft's patency and the patient's overall vascular health. Patients are advised on lifestyle modifications and may be prescribed medications to manage risk factors associated with peripheral vascular disease.

Short Descr ARTERY BYPASS GRAFT
Medium Descr BYP W/VEIN AORTOFEMPOP
Long Descr Bypass graft, with vein; aortofemoral-popliteal
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Discontinued Code
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) none
MUE Not applicable/unspecified.
CCS Clinical Classification 55 - Peripheral vascular bypass
Date
Action
Notes
2012-01-01 Deleted Code deleted, see 35539, 35540, 35556, 35583
Pre-1990 Added Code added.
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