CPT® Code 35646

An aortobifemoral bypass graft, coded as CPT® 35646, is a surgical procedure designed to create a bypass around a diseased or obstructed section of the aorta and one or both iliac arteries using a synthetic graft rather than a vein. This procedure is indicated for patients who have significant vascular disease affecting the aorta and iliac arteries, which can lead to reduced blood flow to the lower extremities. The surgery involves accessing the abdominal cavity, mobilizing the small intestine, and opening the retroperitoneum to expose the aorta. The proximal aorta is carefully dissected to allow for the placement of a vascular cross clamp, which temporarily halts blood flow during the procedure. The iliac arteries are also dissected to facilitate the placement of the graft limbs. The surgical team creates tunnels over the iliac arteries to position the graft, which is a bifurcated synthetic graft designed to connect the aorta to both femoral arteries. This complex procedure requires meticulous attention to detail to ensure proper anastomosis and restoration of blood flow to the lower extremities, ultimately improving the patient's vascular health and quality of life.