Name of the Procedure:

Thromboendarterectomy, including patch graft, if performed; superficial femoral artery Common name(s): Femoropopliteal Thromboendarterectomy, Femoral Artery Endarterectomy

Summary

Thromboendarterectomy is a surgical procedure to remove atherosclerotic plaque from the superficial femoral artery to restore proper blood flow. This can sometimes involve a patch graft to repair the artery.

Purpose

This procedure addresses peripheral artery disease (PAD), which can restrict blood flow to the legs and cause symptoms such as pain, cramping, or ulcers. The goal is to alleviate symptoms, improve limb mobility, and prevent limb loss.

Indications

• Severe leg pain (claudication) during exercise or even at rest.
• Non-healing wounds or ulcers on the legs.
• Gangrene or significant tissue damage due to poor blood flow.
• Evidence of significant arterial blockage on imaging studies.
• Failure of less invasive treatments such as medications or angioplasty.

Preparation

• Fasting for 8 hours before the procedure.
• Temporary cessation of certain medications, as advised by the doctor.
• Blood tests, imaging studies (such as an angiogram), and a physical examination.
• Discussion of current medications and allergies with the healthcare team.

Procedure Description

1. The patient is placed under general or regional anesthesia.
2. An incision is made over the femoral artery.
3. The artery is opened, and atherosclerotic plaque is meticulously removed.
4. A patch graft (usually made from synthetic material or autologous vein) may be sewn into place to widen the artery and ensure it remains open.
5. The artery and incision are then closed, and blood flow is restored.

Tools/Equipment: Surgical instruments, patch graft materials, imaging technology (such as fluoroscopy).

Duration

The procedure typically takes about 2 to 3 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Vascular surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection at the surgical site
• Bleeding and hematoma formation
• Blood clots (thrombosis)
• Damage to adjacent nerves or blood vessels
• Re-narrowing of the artery (restenosis)
• Graft rejection or complications (if a patch graft is used)

Benefits

• Improved blood flow to the leg
• Relief from pain and cramping
• Healing of ulcers or wounds
• Preservation of limb and enhanced mobility
• Reduced risk of severe complications, such as gangrene

Recovery

• Hospital stay of 1-2 days post-procedure.
• Pain management with prescribed medications.
• Instructions for wound care and signs of infection.
• Gradual resumption of normal activities, usually within a week.
• Follow-up appointments for monitoring and possible imaging studies to ensure the artery remains open.

Alternatives

• Angioplasty with or without stenting.
• Bypass surgery.
• Medications such as antiplatelet drugs and vasodilators.
• Lifestyle changes (e.g., smoking cessation, exercise, diet).

Pros and Cons of Alternatives: Less invasive options like angioplasty are often preferred initially but may not be as effective in severe cases. Bypass surgery is more extensive and has a longer recovery period. Medications and lifestyle changes may suffice for milder cases but are not curative for significant blockages.

Patient Experience

Patients may feel groggy post-anesthesia and experience some discomfort at the incision site. Pain is usually manageable with medications. Some swelling and bruising are common. During recovery, activity is limited to allow healing, and the patient may need assistance with daily tasks. Full recovery typically occurs within a few weeks.