CPT® Code 35650

An axillary-axillary bypass graft is a surgical procedure designed to create a new pathway for blood flow around a diseased or obstructed segment of the axillary artery, which is located in the upper arm region. This procedure is particularly indicated for patients who have significant arterial disease affecting the contralateral axillary artery, meaning the artery on the opposite side of the body. The surgery begins with a skin incision made just below the clavicle, allowing access to the underlying soft tissues. Surgeons then carefully dissect through these tissues to expose the proximal end of the first axillary artery. This process is mirrored on the opposite side to expose the second axillary artery. Once both arteries are accessible, a tunnel is created across the chest, connecting the two axillary arteries. A synthetic graft, which is a tubular structure made from biocompatible materials, is selected based on the required size for optimal fit and blood flow. The procedure involves applying vascular clamps to the first axillary artery to control blood flow, followed by an incision to prepare the artery for grafting. The synthetic graft is then sutured to the first axillary artery, and it is passed through the tunnel created earlier. The same steps are repeated for the second axillary artery, where it is clamped, incised, and sutured to the other end of the graft. After the graft is securely in place, the vascular clamps are removed, and the surgeon checks for proper blood flow through the graft using Doppler ultrasound, while also evaluating distal pulses to confirm the patency and functionality of the bypass graft.