CPT® Code 35563

The CPT® Code 35563 refers to a surgical procedure known as an ilioiliac bypass graft using vein. This procedure is indicated for patients who require a bypass of the iliac arteries, which are major blood vessels located in the pelvis that supply blood to the lower limbs. The surgery involves opening the abdomen to gain access to the iliac arteries, allowing the surgeon to expose and dissect these arteries free from surrounding tissues. A critical aspect of this procedure is the creation of an abdominal tunnel, which facilitates the placement of a cross-over graft that connects one iliac artery to the other, effectively bypassing any obstructions that may be present. During the procedure, a vein graft is harvested, typically from the saphenous vein located in the leg. The harvesting process involves making an incision over the section of the saphenous vein to be used, followed by careful dissection to free the vein from surrounding soft tissue. Branches of the vein are ligated and divided, and the selected segment of the vein is ligated at both ends, divided, and removed. Once the vein graft is prepared, the surgeon clamps the iliac artery on the unobstructed side, incises it, and sutures the proximal end of the graft to this artery. The graft is then passed through the previously created tunnel to the contralateral iliac artery, which is also clamped and incised for the distal anastomosis. After the graft is secured to both iliac arteries, vascular clamps are released, and the surgeon checks the suture lines for hemostasis to ensure there is no bleeding. The patency of the bypass graft is confirmed by assessing blood flow using Doppler ultrasound and evaluating distal pulses. This comprehensive approach ensures that the bypass graft functions effectively, restoring adequate blood flow to the lower extremities.