Name of the Procedure:

Thromboendarterectomy, including patch graft, if performed; tibioperoneal trunk artery

Summary

Thromboendarterectomy is a surgical procedure that removes a blood clot and atherosclerotic plaque from an artery, in this case, the tibioperoneal trunk. A patch graft may be added to ensure the artery remains open and functions properly.

Purpose

The procedure addresses blockages in the tibioperoneal trunk artery, which can lead to reduced blood flow to the lower leg and foot. The primary goal is to restore normal blood circulation and prevent complications such as pain, tissue damage, or limb loss.

Indications

• Severe peripheral artery disease (PAD)
• Symptoms like pain, ulcers, or wounds in the lower leg that do not heal
• Risk of limb ischemia (reduced blood flow)

Preparation

• Patients may be instructed to fast for 8-12 hours before the surgery.
• Pre-operative assessments may include blood tests, imaging studies (e.g., ultrasound, angiography), and physical examination.
• Medication adjustments might be necessary, especially for blood thinners.

Procedure Description

1. The patient is administered regional or general anesthesia.
2. An incision is made over the tibioperoneal trunk artery.
3. The affected artery is exposed, and blood flow is temporarily diverted.
4. The blood clot and plaque are carefully removed from the artery.
5. If necessary, a patch graft is used to widen the artery and ensure stable blood flow.
6. The incision is closed, and normal blood flow is restored.

Duration

The procedure typically takes between 1.5 to 3 hours, depending on the complexity.

Setting

It is usually performed in a hospital's operating room.

Personnel

• Vascular surgeon
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Common risks: bleeding, infection, or injury to nearby nerves or tissues
• Rare risks: blood clots, graft failure, or stroke
• Complications may require additional surgery or interventions to manage.

Benefits

• Restored blood flow to the lower leg
• Relief from symptoms like pain and ulcers
• Reduced risk of limb ischemia or amputation
• Benefits are typically noticed within a few weeks after the procedure.

Recovery

• Patients may stay in the hospital for a few days for monitoring.
• Instructions may include wound care, limited physical activity, and follow-up appointments.
• Full recovery may take several weeks, including restrictions on strenuous activities.

Alternatives

• Medication management and lifestyle changes (e.g., exercise, diet)
• Angioplasty and stenting to open the blocked artery
• Pros and cons should be discussed with a healthcare provider, as some alternatives may not be suitable for severe cases.

Patient Experience

• During the procedure, the patient is under anesthesia and should not feel pain.
• Post-procedure, there may be discomfort or soreness at the incision site, managed with pain medication.
• Gradual improvement in symptoms and overall limb function can be expected with successful recovery.