35875

Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula)

CPT code 35875 represents the surgical excision of a blood clot (thrombectomy) from a previously placed arterial or venous bypass graft. This code explicitly excludes hemodialysis grafts or arteriovenous fistulas, which are reported using a different set of codes. The procedure is clinically indicated when a patient presents with graft thrombosis, leading to signs of acute or subacute limb ischemia, such as pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia (the six Ps). Graft failure due to thrombosis can result from poor inflow or outflow, intimal hyperplasia, or technical errors during the initial bypass surgery. To salvage the graft and restore adequate tissue perfusion, prompt surgical intervention is critically required. During the procedure, the vascular surgeon typically performs an open surgical exposure of the affected graft, usually at the site of the proximal or distal anastomosis, or by reopening a prior surgical incision. Vascular control is meticulously obtained both proximal and distal to the clot using specialized vascular clamps or silastic vessel loops. Following the administration of systemic anticoagulation (typically heparin), a transverse or longitudinal graftotomy is carefully made. A balloon-tipped Fogarty embolectomy catheter is then advanced through the graftotomy and navigated past the obstructing thrombus. Once positioned appropriately, the catheter balloon is inflated, and the device is steadily withdrawn to extrude the clot from the lumen. This delicate sweeping process is systematically repeated until robust antegrade and retrograde blood flow is definitively established, confirming the complete removal of the thrombus. Regional heparinized saline is often utilized to flush the vessels and clear microscopic debris. Once the graft is confirmed clear, the surgeon closes the graftotomy. This closure may occasionally incorporate a synthetic or autologous vein patch angioplasty to prevent luminal narrowing, although major structural revisions, such as graft extension or segmental bypass revision, would necessitate upcoding the procedure to CPT 35876. Finally, strict hemostasis is ensured, and the surgical site is approximated and closed in standard anatomical layers. This open procedure remains crucial for immediate limb salvage in patients who have previously undergone peripheral bypass surgery and subsequently developed acute graft occlusion threatening limb viability.

Clinical Indications

  • Acute graft thrombosis in a peripheral arterial bypass (e.g., femoropopliteal, femorotibial).
  • Sudden onset of limb ischemia (pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia) in a patient with a known non-hemodialysis vascular graft.
  • Loss of previously palpable pulses or detectable Doppler signals over a bypass graft.
  • Subacute graft occlusion causing severe disabling claudication or rest pain.
  • Salvage of a failing arterial or venous graft identified on duplex ultrasound showing extensive thrombus.

Procedure Steps

  1. Patient positioning and administration of general, regional, or local anesthesia depending on the surgical site and patient status.
  2. Preparation and draping of the operative area in a standard sterile fashion.
  3. Incision over the graft, often utilizing the prior surgical scar (e.g., groin or lower extremity incision).
  4. Dissection to expose the graft and native vessels, obtaining proximal and distal vascular control using vessel loops or vascular clamps.
  5. Administration of systemic heparin to prevent further thrombosis.
  6. Creation of a transverse or longitudinal graftotomy at an appropriate location to access the thrombus.
  7. Insertion of a balloon-tipped Fogarty embolectomy catheter into the graft lumen.
  8. Advancement of the catheter past the thrombus, inflation of the balloon, and withdrawal to extrude the clot.
  9. Repetition of catheter passes until vigorous antegrade and retrograde blood flow is established.
  10. Flushing of the graft and adjacent vessels with heparinized saline.
  11. Closure of the graftotomy using continuous non-absorbable sutures, occasionally incorporating a patch angioplasty to prevent narrowing.
  12. Release of vascular clamps and confirmation of restored perfusion to the distal extremity via Doppler or palpation.
  13. Irrigation of the wound, achievement of hemostasis, and closure of the incision in multiple anatomic layers.

Coding Guidelines

  • Do not report 35875 for thrombectomy of a hemodialysis graft or arteriovenous fistula; use codes 36901-36909 as appropriate.
  • If the thrombectomy requires a revision of the arterial or venous graft, use CPT code 35876 instead.
  • Code 35875 applies to open thrombectomy. For percutaneous mechanical thrombectomy, see 37184-37188.
  • Do not report 35875 in conjunction with 34201 or 34203 if performed on the same bypass graft, as thrombectomy of a graft is distinct from native artery embolectomy.
  • Intraoperative angiography may be reported separately if medical necessity is met and properly documented (e.g., using 75898 or appropriate radiological supervision and interpretation codes), adhering to NCCI edits.
  • Modifier 59 or X-modifiers may be required if performed on a separate distinct vessel or graft from other concurrent procedures.

Associated ICD-10 Codes