Name of the Procedure:

Embolectomy or Thrombectomy, with or without Catheter; Axillary, Brachial, Innominate, Subclavian Artery, by Arm Incision

Summary

An embolectomy or thrombectomy is a surgical procedure to remove a blood clot (embolus or thrombus) from an artery in the arm. By making a small incision in the arm, the surgeon can access and remove the clot, helping to restore normal blood flow.

Purpose

This procedure is performed to address arterial blockages caused by blood clots that can restrict blood flow to the arm, leading to pain, tissue damage, or even loss of function. The primary goal is to remove the clot and restore proper circulation.

Indications

• Severe arm pain due to blocked blood flow
• Symptoms of tissue ischemia (such as pale or blue skin)
• Signs of advanced limb ischemia (ulcers or gangrene)
• Diagnostic imaging showing a blood clot in the specified arteries
• Failure of other less invasive treatments like medication or thrombolysis

Preparation

• Fasting for at least 8 hours before the procedure
• Discontinuation of certain medications as advised by the physician
• Blood tests, imaging studies such as an ultrasound, CT, or MRI
• Discussion of medical history and allergies with the healthcare team

Procedure Description

1. The patient is typically given local or general anesthesia.
2. A small incision is made in the arm above the site of the clot.
3. Depending on the location and size of the clot, various tools (catheters, balloon devices, or surgical instruments) are used to remove the clot.
4. Once the clot is removed, the incision is closed with sutures.
5. The success of the procedure is confirmed using imaging technology to ensure the artery is patent.

Duration

The procedure typically takes 1-2 hours, depending on the complexity and location of the clot.

Setting

The procedure is usually performed in a hospital operating room under sterile conditions.

Personnel

• Vascular Surgeon or Interventional Radiologist
• Nurses
• Anesthesiologist (if general anesthesia is used)
• Surgical Technicians

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Re-occlusion of the artery
• Damage to the surrounding nerves or tissues
• Rare risks include stroke, myocardial infarction, or embolization to another site

Benefits

• Restoration of normal blood flow
• Relief from pain and symptoms of ischemia
• Prevention of tissue damage and loss of limb function

Recovery

• Patients may need to stay in the hospital for a day or two for observation.
• Pain management with prescribed medications.
• Keeping the incision site clean and dry.
• Follow-up appointments to monitor healing and blood flow.
• Avoiding strenuous activities and heavy lifting for a few weeks.

Alternatives

• Medications such as anticoagulants or thrombolytics
• Endovascular procedures like angioplasty or stenting
• Conservative management with lifestyle modifications
• Amputation in severe, non-recoverable cases

Patient Experience

• During the procedure, patients may feel drowsy or be unconscious if general anesthesia is used.
• Post-operatively, patients might experience mild to moderate pain at the incision site, managed with medications.
• Swelling, bruising, or stiffness in the arm may occur but should improve over time.
• Close follow-up with the healthcare team is essential to ensure proper recovery and to address any complications swiftly.