35361 Thromboendarterectomy, including patch graft, if performed; combined aortoiliac

Name of the Procedure:

Thromboendarterectomy, including patch graft, if performed; combined aortoiliac.

Summary

Thromboendarterectomy is a surgical procedure designed to remove a blood clot and the lining of a blocked artery. When performed on the aorta and iliac arteries combined, it may include the use of a patch graft to repair the artery and restore proper blood flow.

Purpose

This procedure addresses peripheral artery disease (PAD) where blood vessels supplying blood to the limbs are narrowed or blocked. The goal is to remove the blockage, restore adequate blood flow, and reduce symptoms like pain and improve mobility.

Indications

• Severe PAD symptoms like chronic leg pain, cramping, or ulcers.
• Critical limb ischemia, where blood flow to the limbs is severely limited.
• Failure of non-surgical treatments such as medication and lifestyle changes.

Preparation

• Fasting for 8-12 hours before the procedure.
• Adjustments to current medications (e.g., blood thinners) as directed by the physician.
• Preoperative diagnostic tests, such as blood tests, imaging studies (e.g., CT angiography), and cardiovascular assessments.

Procedure Description

1. The patient is placed under general anesthesia for deep sedation and pain management.
2. An incision is made to access the affected area of the aorta and iliac arteries.
3. The surgeon identifies and removes the blood clot along with the inner lining of the artery (endarterectomy).
4. A patch graft is sewn in place to widen the artery and ensure a smooth blood flow.
5. The incision is closed, and the area is bandaged.

Duration

The procedure typically takes 3-4 hours, depending on the complexity.

Setting

The procedure is performed in a hospital setting, specifically in a surgical suite.

Personnel

• Vascular surgeon
• Surgical assistants
• Nursing staff
• Anesthesiologist

Risks and Complications

• Common risks: bleeding, infection, and reactions to anesthesia.
• Rare risks: damage to surrounding organs or tissues, blood clots, and need for further surgical intervention.
• Management includes monitoring, medication, and, if necessary, additional procedures.

Benefits

• Improved blood flow to the legs and reduced symptoms like pain and ulcers.
• Enhanced mobility and quality of life.
• Benefits are typically realized shortly after recovery from surgery.

Recovery

• Post-procedure hospital stay of 2-4 days for monitoring.
• Pain management typically involves medications prescribed by the healthcare team.
• Expected recovery time ranges from a few weeks to a couple of months.
• Restrictions include avoiding strenuous activities and follow-up appointments for progress evaluation and suture removal.

Alternatives

• Angioplasty with stent placement: less invasive, quicker recovery but might be less effective for extensive blockages.
• Bypass surgery: an alternative when thromboendarterectomy is not feasible, involves creating a detour around the blocked artery.
• Conservative treatments like medication and lifestyle changes: recommended for less severe conditions.

Patient Experience

During the procedure, the patient will be under anesthesia, ensuring no pain or discomfort. Post-procedure, there might be some pain at the incision site, managed with medications. Temporary swelling and bruising are common. The healthcare team will provide measures to ensure comfort and promote a swift recovery.