Clinical Context
A typical patient is a 68-year-old male with progressive left-sided claudication and diminished distal pulses. Noninvasive testing (ankle-brachial index and duplex ultrasound) demonstrates hemodynamically significant stenosis of the left common iliac artery. The vascular surgery team schedules endarterectomy or percutaneous transluminal intervention to restore blood flow. Pre-procedure workflow includes focused history and physical, review of prior imaging (CTA or MRA of the pelvis), assessment of anticoagulation and contrast allergy, and informed consent documenting risks (bleeding, infection, embolization, vessel injury). In the operating room or angiography suite, the provider performs percutaneous or open access, confirms the lesion with angiography, and proceeds with plaque removal (open endarterectomy or directional/aspiration thrombectomy and adjunctive balloon angioplasty/stent placement as indicated). Post-procedure workflow includes hemostasis management, limb perfusion assessment, monitoring for access site complications, antiplatelet/anticoagulation management, and discharge planning with follow-up vascular laboratory testing.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
0238T | Restoration of blood supply in narrowed or blocked portion or branch of the iliac artery; removal of deposited plaque through open or percutaneous approach | Primary procedure restoring iliac artery blood flow via plaque removal. |
| 37220 | Revascularization, endovascular, open or percutaneous, iliac artery, initial vessel; with transluminal angioplasty | Often performed in conjunction when angioplasty is required after plaque removal or when percutaneous approaches are used.
| 37221 | Revascularization, endovascular, open or percutaneous, iliac artery, initial vessel; with stent placement | Used when stent deployment is indicated after plaque removal to maintain vessel patency.
| 35476 | Thrombectomy of iliac artery by catheter; with distal embolic protection | May be used when catheter-based thrombectomy is performed for occlusive thrombus in the iliac segment.
| 35831 | Endarterectomy, other than carotid, including patch graft, if performed; iliac/femoral region | Used for open surgical endarterectomy with patching in the iliac/femoral territory when coded separately per payer rules.
| 76000 | Fluoroscopic guidance for vascular procedures | Imaging guidance commonly reported by facility or physician when separate reporting is allowed.