CPT® Code 35686

Add-On Code

Creation of distal arteriovenous fistula during lower extremity bypass surgery (non-hemodialysis) (List separately in addition to code for primary procedure)

The CPT® Code 35686 refers to the creation of a distal arteriovenous fistula during lower extremity bypass surgery, specifically for non-hemodialysis purposes. This procedure is indicated when there is inadequate blood outflow from the bypass graft to the remaining segment of the native artery, which can compromise the effectiveness of the bypass. The creation of a fistula serves to enhance blood flow within the graft by establishing an additional venous outflow pathway to the lower extremity artery. During the procedure, the surgeon meticulously dissects the affected artery and a segment of the adjacent vein from the surrounding tissues to prepare for the fistula creation. The branches of the vein are ligated to prevent blood flow in those areas, and the distal end of the vein utilized for the fistula is also ligated. Subsequently, an incision is made in the native vein, and a modified venous bypass graft is anastomosed to both the native artery and the native vein, resulting in the formation of a distal arteriovenous fistula. This surgical intervention is performed as a separate procedure in addition to the primary bypass surgery, highlighting its significance in improving graft function and overall lower extremity circulation.