Name of the Procedure:

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, common femoral artery (profunda femoris, superficial femoral).

Summary

This procedure involves repairing or removing a part of an aneurysm or pseudoaneurysm (a bulge in a blood vessel) in the common femoral artery. A graft may also be inserted to replace the damaged section. It is typically performed to address a ruptured aneurysm which can cause serious bleeding and other complications.

Purpose

Medical condition or problem it addresses:

• Ruptured aneurysms or pseudoaneurysms in the common femoral artery.

Goals or expected outcomes:

• To repair the weakened or ruptured artery, halt internal bleeding, and restore normal blood flow.

Indications

Specific symptoms or conditions:

• Severe pain and swelling in the thigh or groin area.
• A palpable pulsatile mass along the artery.
• Signs of internal bleeding and shock.

Patient criteria:

• Presence of a ruptured aneurysm or pseudoaneurysm diagnosed through imaging studies.
• Failure of less invasive treatments to manage the aneurysm.

Preparation

Pre-procedure instructions:

• Fasting for a specified period before the procedure (typically 8-12 hours).
• Adjustments in medications as advised by the doctor, particularly blood thinners.

Diagnostic tests or assessments:

• Imaging tests such as ultrasound, CT scan, or MRI to visualize the aneurysm.
• Blood tests to assess overall health and readiness for surgery.

Procedure Description

Step-by-step explanation:

1. The patient is placed under general anesthesia.
2. An incision is made over the common femoral artery to expose the aneurysm.
3. Clamps are applied to control blood flow.
4. The aneurysm or pseudoaneurysm is repaired or excised.
5. A graft, which may be synthetic or sourced from the patient's body, is inserted to replace the damaged part of the artery.
6. In some cases, a patch graft is used to reinforce the artery.
7. The incisions are closed, and blood flow is restored.

Tools and equipment:

• Vascular clamps, surgical instruments for dissection, graft materials.

Anesthesia:

• General anesthesia is typically used to ensure the patient is unconscious and pain-free during the procedure.

Duration

• The procedure generally takes between 2 to 4 hours, depending on the complexity of the aneurysm and the extent of the repair needed.

Setting

• This procedure is performed in a hospital surgical suite.

Personnel

• The surgical team typically includes a vascular surgeon, an anesthesiologist, surgical nurses, and possibly a surgical technologist.

Risks and Complications

Common risks:

• Infection at the incision site.
• Bleeding or hematoma formation.
• Blood clots.

Rare risks:

• Graft infection or rejection.
• Nerve damage.
• Long-term complications such as graft occlusion or stenosis.

Management of complications:

• Immediate medical intervention and additional treatments such as antibiotics or additional surgical procedures.

Benefits

Expected benefits:

• Immediate cessation of bleeding and stabilization of the patient.
• Restoration of normal blood flow to the affected limb.

Realization time:

• Benefits are typically immediate post-surgery, with significant improvement in symptoms as recovery progresses.

Recovery

Post-procedure care:

• Monitoring in the intensive care unit (ICU) initially.
• Pain management with prescribed medications.
• Instructions on wound care and signs of infection to watch for.

Expected recovery time:

• Full recovery can take several weeks to months, with follow-up appointments to monitor progress.

Restrictions and follow-up:

• Restricted physical activity, especially avoiding heavy lifting, until cleared by the surgeon.
• Regular follow-ups to ensure the graft is functioning properly.

Alternatives

Other treatment options:

• Endovascular repair using stents or coils.
• Conservative management with medications and lifestyle changes.

Pros and cons of alternatives:

• Endovascular repair: Less invasive, shorter recovery time, but may not be suitable for all aneurysm locations or sizes.
• Conservative management: Non-surgical, but may not adequately address large or ruptured aneurysms.

Patient Experience

During the procedure:

• The patient will be under general anesthesia and will not feel any discomfort during the surgery.

After the procedure:

• Post-operative pain managed with medications.
• Initial discomfort and limited mobility as healing progresses.
• Full recovery and return to normal activities may take time, with gradual improvement noted in follow-up visits.