34705

Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the iliac bifurcation; for other than rupture (e.g., for aneurysm, pseudoaneurysm, dissection, penetrating ulcer)

CPT code 34705 describes the endovascular repair of the infrarenal aorta and/or iliac arteries using an aorto-uni-iliac (AUI) endograft for conditions other than rupture, such as an intact abdominal aortic aneurysm (AAA), pseudoaneurysm, penetrating atherosclerotic ulcer, or localized dissection. This highly complex endovascular procedure is typically chosen when patient anatomy, such as severe unilateral iliac occlusive disease, excessive vessel tortuosity, or an exceptionally narrow distal aortic bifurcation, precludes the safe use of a standard bifurcated endograft. In this approach, the endograft is deployed to bridge the healthy aorta, located below the level of the renal arteries, to one of the iliac arteries, thereby effectively excluding the diseased segment or aneurysmal sac from the high-pressure systemic circulation. The code encompasses a comprehensive suite of intraoperative services. It inherently includes the pre-procedure sizing and precise device selection based on advanced imaging. During the procedure, the provider establishes vascular access, which is often performed via open femoral cutdown or percutaneous techniques (which are billed separately depending on the exact access method utilized). Once access is established, the provider performs all necessary non-selective catheterizations required for the placement of the endograft. Crucially, CPT 34705 bundles all associated radiological supervision and interpretation, including fluoroscopy and intraoperative angiography, needed for device navigation and accurate deployment. Furthermore, the code includes the placement of any necessary endograft extensions within the specific treatment zone extending from the level of the renal arteries down to the iliac bifurcation, as well as any balloon angioplasty or stenting performed within this targeted anatomical segment to ensure optimal graft apposition and seal. Physicians must carefully adhere to coding guidelines, noting that while the primary AUI deployment and intra-procedural imaging are bundled, adjunctive procedures frequently required during an AUI repair, such as a femorofemoral crossover bypass to restore perfusion to the contralateral lower extremity, or the deployment of an occlusion device in the contralateral common iliac artery to prevent retrograde endoleak, are typically reported with separate CPT codes. Completion angiography is performed at the conclusion of the graft deployment to confirm the complete exclusion of the aneurysm and to verify that there are no endoleaks present, finalizing the primary endovascular repair.

Clinical Indications

  • Infrarenal abdominal aortic aneurysm (AAA) without rupture.
  • Aortic pseudoaneurysm located below the renal arteries.
  • Penetrating atherosclerotic ulcer (PAU) of the infrarenal aorta.
  • Focal dissection of the infrarenal abdominal aorta.
  • Patients anatomically unsuitable for a standard bifurcated endograft due to severe unilateral iliac occlusive disease, narrow aortic bifurcation, or extreme tortuosity.

Procedure Steps

  1. Patient is placed under general, regional, or local anesthesia and the surgical sites are prepped and draped.
  2. Vascular access is obtained, typically via bilateral common femoral arteries using percutaneous techniques or open surgical cutdown (reported separately).
  3. Guidewires and introducer sheaths are advanced into the femoral arteries under fluoroscopic guidance.
  4. An initial angiogram is performed to map the anatomy of the aorta, renal arteries, and iliac arteries.
  5. Measurements are taken to confirm pre-operative sizing and select the appropriate aorto-uni-iliac (AUI) endograft.
  6. The main body of the AUI endograft is advanced over the stiff guidewire into the infrarenal aorta.
  7. Under continuous fluoroscopic imaging, the endograft is positioned just below the lowest renal artery and deployed, extending down into the selected common or external iliac artery.
  8. Additional endograft extensions are placed within the aorta to iliac bifurcation zone if required to achieve adequate seal.
  9. Balloon angioplasty (and stenting if necessary) is performed within the treatment zone to fully expand the endograft and ensure optimal wall apposition.
  10. A completion angiogram is performed to verify the exclusion of the aneurysm, confirm patency of the renal arteries, and check for any endoleaks.
  11. The delivery systems and sheaths are removed, and the arteriotomies are closed using primary repair, patch angioplasty, or percutaneous closure devices.

Coding Guidelines

  • Includes pre-procedure sizing and device selection.
  • Includes all non-selective catheterizations performed during the procedure.
  • Includes all associated radiological supervision and interpretation (e.g., fluoroscopy, intraoperative angiography).
  • Includes all endograft extensions placed in the aorta from the level of the renal arteries to the iliac bifurcation.
  • Includes all angioplasty and/or stenting performed within the treatment zone (renal arteries to iliac bifurcation).
  • Do not report 34705 in conjunction with standard radiological S&I codes for the primary procedure as they are bundled.
  • Report separately: Vascular access procedures such as open femoral artery exposure (e.g., 34812) or percutaneous access (e.g., 34713).
  • Report separately: Femorofemoral crossover bypass graft, which is almost always required with an AUI endograft to supply the contralateral limb.
  • Report separately: Occlusion of the contralateral common iliac artery, usually required to prevent retrograde flow into the aneurysm sac.
  • Report separately: Ultrasound guidance for vascular access (76937), if properly documented.
  • If the procedure is performed for a ruptured aneurysm, use code 34706 instead of 34705.

Associated ICD-10 Codes