CPT® Code 35623

An axillary-popliteal or axillary-tibial bypass graft, coded as CPT® 35623, is a surgical procedure designed to reroute blood flow around a diseased or obstructed segment of the vascular system, specifically targeting the aorta, iliac, and/or femoral arteries. This procedure is performed using a synthetic graft rather than a vein, which is significant in cases where the patient's veins may not be suitable for grafting due to disease or other factors. The surgery begins with a skin incision made in the chest area, just below the clavicle, allowing access to the proximal axillary artery. A second incision is then made in the groin region over the common femoral artery or in the leg over the popliteal or tibial artery, facilitating exposure of the necessary arteries for the bypass. The surgical team creates a tunnel that connects the axillary artery to the common femoral artery, or extends further down to the popliteal or tibial artery, depending on the specific bypass being performed. This tunnel is crucial for the placement of the synthetic graft, which is selected based on the size required for optimal blood flow. Once the graft is in place, it is sutured to both the axillary artery and the distal artery, ensuring a secure connection. The procedure concludes with the removal of vascular clamps and verification of blood flow through the graft, typically assessed using Doppler ultrasound, along with an evaluation of distal pulses to confirm the patency of the bypass graft. This detailed approach ensures that blood can flow effectively around the obstructed area, restoring circulation to the lower extremities.