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CPT®
35651

CPT® Code 35651
Deleted

Code deleted, see 35646, 35647, 35656

Official Description

Bypass graft, with other than vein; aortofemoral-popliteal

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 35651 refers to a surgical procedure known as a bypass graft, specifically an aortofemoral-popliteal bypass graft that utilizes a synthetic material rather than a vein. This procedure is performed to create a new pathway for blood flow around an obstructed section of the aorta, which is the main artery supplying blood to the lower body. The bypass graft connects the aorta to the femoral artery, which is located in the groin, and extends down to the popliteal artery, situated behind the knee. The procedure involves several critical steps, including the opening of the abdomen and retroperitoneum to access the aorta, the creation of a tunnel for the graft, and the careful anastomosis of the graft to both the aorta and the popliteal artery. The use of a synthetic graft is particularly important in cases where the patient's veins are not suitable for grafting. This procedure is essential for restoring adequate blood flow to the lower extremities, which can alleviate symptoms associated with peripheral artery disease and improve overall limb health.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The aortofemoral-popliteal bypass graft procedure, coded as CPT® 35651, is indicated for patients experiencing significant arterial obstruction that impairs blood flow to the lower extremities. The following conditions may warrant this surgical intervention:

  • Peripheral Artery Disease (PAD) - A condition characterized by narrowed arteries reducing blood flow to the limbs, often leading to pain and mobility issues.
  • Critical Limb Ischemia - A severe obstruction of the arteries that significantly reduces blood flow, potentially resulting in pain at rest, non-healing wounds, or gangrene.
  • Rest Pain - Pain in the legs or feet that occurs while resting, indicating severe arterial blockage.
  • Non-healing Ulcers or Wounds - Ulcers or wounds on the lower extremities that do not heal due to inadequate blood supply.

2. Procedure

The aortofemoral-popliteal bypass graft procedure involves several detailed steps to ensure successful grafting and restoration of blood flow. The following outlines the procedural steps:

  • Step 1: Abdominal Access - The procedure begins with an incision in the abdomen to gain access to the aorta. The small intestine is mobilized to provide a clear view of the retroperitoneal space.
  • Step 2: Exposure of the Aorta - The retroperitoneum is opened, allowing the surgeon to dissect the aorta free from surrounding tissues, facilitating the creation of a graft tunnel.
  • Step 3: Tunnel Creation - A tunnel is created from the aorta over the iliac artery, which is essential for guiding the synthetic graft towards the femoral artery.
  • Step 4: Incision on the Affected Side - A groin incision is made on the side of the obstruction to expose the femoral artery, which is critical for the anastomosis.
  • Step 5: Exposure of the Popliteal Artery - An additional incision is made behind the knee to expose the planned anastomosis site in the popliteal artery.
  • Step 6: Graft Preparation - An appropriately sized tubular synthetic graft is selected and prepared for implantation, ensuring it meets the necessary specifications for the patient's anatomy.
  • Step 7: Anastomosis to the Aorta - The aorta is clamped and incised, after which the synthetic graft is anastomosed to the aorta, establishing the primary connection for blood flow.
  • Step 8: Anastomosis to the Popliteal Artery - The popliteal artery is also clamped and incised, allowing for the distal end of the graft to be anastomosed, completing the bypass pathway.
  • Step 9: Hemostasis and Flow Check - After the anastomoses are completed, vascular clamps are released, and hemostasis at all anastomosis sites is checked. Blood flow through the graft is assessed using Doppler ultrasound, and distal pulses are evaluated to ensure the graft is patent and functioning correctly.

3. Post-Procedure

Post-procedure care for patients undergoing an aortofemoral-popliteal bypass graft includes monitoring for complications such as bleeding, infection, or graft failure. Patients are typically observed in a recovery area where vital signs are closely monitored. Pain management is provided as needed, and patients may be encouraged to begin light ambulation as soon as it is safe to do so. Follow-up appointments are essential to assess the graft's patency and overall limb health, and patients may require imaging studies to evaluate blood flow in the bypass graft over time.
Short Descr ARTERY BYPASS GRAFT
Medium Descr BYP OTH/THN VEIN AORTOFEMPOP
Long Descr Bypass graft, with other than vein; aortofemoral-popliteal
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Discontinued Code
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) none
MUE Not applicable/unspecified.
CCS Clinical Classification 55 - Peripheral vascular bypass
Date
Action
Notes
2012-01-01 Deleted Code deleted, see 35646, 35647, 35656
Pre-1990 Added Code added.
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