CPT® Code 35691

The procedure described by CPT® Code 35691 involves the surgical transposition and/or reimplantation of the vertebral artery to the carotid artery. This complex vascular surgery is performed to address specific conditions affecting blood flow in the vertebral artery, which is a critical vessel supplying blood to the posterior part of the brain. The procedure begins with the physician making an incision in the neck to expose the vertebral artery, allowing for direct access to the vessel. A systemic anticoagulant is administered intravenously to prevent clotting during the procedure. The surgeon then assesses the available length of the vertebral artery to determine the feasibility of the anastomosis, which is the surgical connection between two vessels. In this procedure, the anastomosis site on the common carotid artery is carefully marked to ensure precise alignment during the connection. The vertebral artery is clamped just below the longus colli muscle, and a ligature is placed at its origin. The artery is then transected above the ligature, allowing it to be maneuvered through the surrounding anatomical structures, specifically the cervical sympathetic ganglia, to reach the planned anastomosis site. The actual connection is performed in an end-to-side fashion, where the vertebral artery is sutured to the common carotid artery. Before concluding the procedure, the surgeon ensures that blood flow is properly restored by backbleeding the vessels, tying the sutures, and re-establishing blood flow first to the common carotid artery and subsequently to the vertebral artery. This meticulous approach is essential for ensuring the success of the procedure and the restoration of adequate blood supply to the brain. The procedure is critical for patients with vascular issues that may compromise cerebral perfusion, thereby preventing potential neurological deficits.