35303 Thromboendarterectomy, including patch graft, if performed; popliteal artery

Name of the Procedure:

Thromboendarterectomy, including patch graft, if performed; popliteal artery

Summary

In layman's terms, a thromboendarterectomy of the popliteal artery is a surgical procedure in which the inner lining of the artery, containing blockages or blood clots, is removed. A patch graft may be used to widen the artery if necessary.

Purpose

This procedure addresses peripheral artery disease (PAD) or acute limb ischemia caused by blockages in the popliteal artery, which supplies blood to the lower leg. The goal is to restore normal blood flow, relieve symptoms such as pain and cramping, and prevent complications like tissue damage or limb loss.

Indications

• Severe leg pain due to blocked arteries (claudication)
• Non-healing wounds or ulcers on the leg or foot
• Gangrene or tissue death
• Acute limb ischemia with sudden onset of pain, coldness, and numbness

Preparation

• Fasting for 8-12 hours before the procedure
• Medication adjustments, particularly blood thinners
• Pre-operative imaging tests such as Doppler ultrasound, CT angiography, or MRI
• Blood tests to assess overall health

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A surgical cut is made over the popliteal artery behind the knee.
3. Isolation and Clamping: The artery is isolated and clamped to temporarily stop blood flow.
4. Endarterectomy: The inner lining of the artery, along with the blockage, is carefully removed.
5. Patch Graft: A synthetic or vein graft may be sewn into place if the artery is narrowed or damaged.
6. Closure: The artery is closed, blood flow is restored, and the incision is sutured.

Duration

Typically, the procedure takes about 2 to 3 hours.

Setting

Performed in a hospital operating room.

Personnel

• Vascular surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a surgical technologist

Risks and Complications

• Infection
• Bleeding or hematoma
• Blood clots or embolism
• Re-narrowing of the artery (restenosis)
• Nerve damage
• Anesthesia-related complications

Benefits

• Improved blood flow to the lower leg and foot
• Relief from pain and other symptoms
• Healing of chronic wounds or ulcers
• Prevention of severe complications like tissue damage or limb loss
• Benefits often begin to be realized within days to weeks post-procedure

Recovery

• Hospital Stay: Usually 1 to 3 days
• Wound Care: Keep the incision site clean and dry; follow wound care instructions.
• Activity: Gradual return to normal activities, avoiding strenuous exercise initially.
• Medications: May include pain relievers, blood thinners, and antibiotics.
• Follow-up: Regular follow-up appointments to monitor healing and blood flow, with possible imaging tests.

Alternatives

• Medication Management: Antiplatelet drugs, cholesterol-lowering agents, or blood thinners.
• Minimally Invasive Procedures: Angioplasty with stent placement.
• Bypass Surgery: Creating a bypass around the blocked section of the artery.

Pros and Cons:

• Medications are less invasive but may not be sufficient for severe cases.
• Angioplasty is less invasive but has a higher risk of restenosis.
• Bypass surgery can be more invasive with a longer recovery time but can offer long-lasting results.

Patient Experience

• During: Under anesthesia, so no pain during the procedure.
• After: Pain at the incision site, managed with pain relievers. Controllable swelling and bruising.
• Pain Management: Pain medication as prescribed; comfort measures such as elevating legs.
• Restoration of Blood Flow: Often leads to a significant reduction in symptoms and improvement in quality of life.