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Anesthesia for procedures on arteries of knee and popliteal area; popliteal thromboendarterectomy, with or without patch graft Synonyms Anesthesia for removal of blood clot in artery behind knee.

• Abstract Aortoiliac reconstruction began with thromboendarterectomy of the aortoiliac and femoral segments. Open endarterectomy was developed first by Dos Santos, followed by the semiclosed technique and, finally, eversion endarterectomy, still used by some. Concerns about the technical challenge of thromboendarterectomy and the better long-term patency of aortofemoral bypass have caused many surgeons to abandon this procedure.

In recent years, attention has turned to extending the bypass more proximally to adequately address disease in the perirenal and visceral aorta, most commonly through an extended retroperitoneal approach. At the same time there has been a resurgence of interest in iliofemoral bypass for patients with unilateral iliac occlusion. Stenotic iliac lesions are now often treated by percutaneous balloon angioplasty, sometimes accompanied by distal cross-femoral reconstruction. An axillobifemoral bypass is occasionally used. Thus, there are now many alternatives in aortoiliac reconstruction, and the approach is currently tailored to each clinical situation 1,2.

Question: Our anesthesiologist provided anesthesia for a carotid thromboendarterectomy, but I'm not sure which anesthesia code best applies? Utah Subscriber Answer: Anesthesia for code CPT 35301 (Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision) uses 00350 (Anesthesia for procedures on major vessels of neck; not otherwise specified). Carotid thromboendarterectomy is the removal of plaque from the carotid artery through an incision in the neck, which typically involves fast recovery and little pain. Patients may be asleep under general anesthesia during surgery, or awake with local anesthesia. Take note: Related anesthesia code 00352 (.simple ligation) does not apply to carotid thromboendarterectomy because the procedure is more involved than a simple ligation.

That is why the NOS choice is best suited for the scenario.