CPT® Code 35587

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. This technique is particularly important for restoring blood flow in cases where arteries are blocked, which can lead to serious complications such as limb ischemia. During the procedure, an incision is made in the leg to expose the saphenous vein, which is then carefully evaluated for its suitability. The proximal and distal ends of the vein are mobilized while leaving the majority of the vein intact. The procedure involves ligating and dividing the saphenous vein at the saphenofemoral junction, ensuring that a cuff of femoral vein is preserved for the anastomosis. The saphenous vein is subsequently connected to the common femoral, proximal superficial femoral, or popliteal artery, allowing arterial blood to flow through the vein after the venous valves are destroyed using a valvulotome. This destruction of the valves is crucial as it prevents backflow and facilitates proper blood circulation. The distal end of the saphenous vein is then ligated and divided, followed by anastomosis to the popliteal, anterior tibial, posterior tibial, or peroneal artery. Throughout the procedure, vascular clamps are used to control blood flow, and hemostasis is meticulously checked at all anastomosis sites. Finally, Doppler ultrasound is employed to confirm blood flow and evaluate distal pulses, ensuring the success and patency of the in-situ bypass.