CPT® Code 35583

An in-situ vein bypass is a surgical procedure that utilizes the patient's own saphenous vein to create a bypass around occluded arteries in the lower extremities, specifically targeting the femoral to popliteal artery region. This procedure is indicated for patients with significant arterial blockages that impede blood flow, potentially leading to severe complications such as limb ischemia. During the operation, a surgical incision is made in the leg to expose the saphenous vein, which is then carefully evaluated for its suitability as a bypass conduit. The proximal and distal segments of the vein are mobilized while preserving the majority of the vein in its original location. The procedure involves ligating and dividing the saphenous vein at the saphenofemoral junction, ensuring a cuff of femoral vein is included for optimal anastomosis. The saphenous vein is subsequently connected to the common femoral artery, proximal superficial femoral artery, or popliteal artery. To facilitate arterial blood flow through the saphenous vein, the venous valves are destroyed using a specialized instrument known as a valvulotome, rendering them incompetent. Additionally, tributaries of the saphenous vein are identified and ligated to prevent complications. The distal end of the saphenous vein is then ligated and divided, followed by anastomosis to the popliteal artery or its branches, including the anterior tibial, posterior tibial, or peroneal arteries. After completing the anastomoses, vascular clamps are released, and hemostasis is meticulously checked at all anastomosis sites. The success of the bypass is confirmed by assessing blood flow using Doppler ultrasound and evaluating distal pulses to ensure the patency of the newly created in-situ bypass.