CPT® Code 35585

An in-situ vein bypass is a surgical procedure that utilizes the saphenous vein to create a bypass around occluded arteries in the lower extremities, specifically targeting the femoral-anterior tibial, femoral-posterior tibial, or femoral-peroneal arteries. This technique is employed when there is a blockage in these arteries that impedes blood flow, potentially leading to complications such as pain, ulcers, or limb ischemia. The procedure begins with an incision 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 saphenous vein is subsequently ligated and divided at the saphenofemoral junction, ensuring a cuff of femoral vein is included for optimal anastomosis. The vein is then connected to the common femoral, proximal superficial femoral, or popliteal artery, allowing arterial blood to flow through the vein after the venous valves are rendered incompetent using a valvulotome. This step is crucial as it facilitates the unidirectional flow of arterial blood through the saphenous vein. Following this, tributaries of the saphenous vein are identified and ligated to prevent complications. The distal end of the saphenous vein is also ligated and divided before being anastomosed to the appropriate artery, such as the popliteal, anterior tibial, posterior tibial, or peroneal artery. After completing the anastomoses, vascular clamps are released, and hemostasis is meticulously checked at all anastomosis sites. Finally, 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.