CPT® Code 35645

A bypass graft, specifically coded as CPT® 35645, refers to a surgical procedure that involves creating a bypass around a diseased or obstructed segment of the vertebral artery using a synthetic graft rather than a vein. This procedure is particularly relevant for patients with conditions affecting the vertebral arteries, which are critical for supplying blood to the brainstem, cerebellum, and occipital lobes. The vertebral arteries originate from the brachiocephalic artery on the right side and the subclavian artery on the left side, entering the cervical spine at the C6 transverse process and traveling through the C6-C2 processes before exiting at the base of the skull. The procedure entails making an incision over the vertebral artery below the obstructed area, carefully dissecting the artery from surrounding tissues, and then utilizing a tubular synthetic graft to restore blood flow. The graft is sutured to the vertebral artery after clamping and incising it, ensuring that blood flow is reestablished and monitored for patency post-surgery. This procedure is essential for maintaining adequate cerebral perfusion in patients with vertebral artery obstructions.