CPT® Code 35694

The procedure described by CPT® Code 35694 involves the surgical transposition and/or reimplantation of the subclavian artery to the carotid artery. This complex vascular surgery is performed to alter the normal pathway of blood flow between these two major arteries, which can be necessary for various medical conditions that affect blood circulation. The procedure typically begins with a supraclavicular incision made at the base of the neck, allowing the surgeon access to the subclavian and carotid arteries. During the operation, the clavicular head is incised, and the scalene fat pad is mobilized and reflected superiorly to expose the underlying structures. The thoracic duct may be preserved or ligated, depending on the specific circumstances of the surgery. The phrenic nerve, which is crucial for diaphragm function, is identified and protected throughout the procedure to prevent complications. The anterior scalene muscle is transected to facilitate access to the arteries. The subclavian artery is then carefully dissected free from surrounding tissues, and its branches are divided and ligated to ensure a clear surgical field. Following this, the carotid artery is also exposed and dissected. The vagus nerve, which plays a significant role in autonomic control of the heart and digestive tract, is similarly identified and protected. A tunnel is created posterior to the jugular vein to facilitate the repositioning of the subclavian artery. Systemic anticoagulation is administered intravenously to minimize the risk of thromboembolic events during the procedure. The subclavian artery is divided, and the proximal stump is oversewn. The artery is then pulled through the tunnel, bringing it into proximity with the carotid artery for anastomosis. The carotid artery is incised, and the end of the subclavian artery is sutured to the side of the carotid artery, completing the transposition. This intricate procedure requires a high level of surgical skill and precision to ensure proper blood flow and minimize complications.