Name of the Procedure:

Thromboendarterectomy, including patch graft, if performed; tibial or peroneal artery, initial vessel

Summary

A thromboendarterectomy is a surgical procedure to remove plaque build-up from the inner lining of an artery, specifically the tibial or peroneal artery in this case. Sometimes, a patch graft is used to widen the artery after plaque removal, improving blood flow and preventing further blockages.

Purpose

Thromboendarterectomy addresses peripheral artery disease (PAD), where plaque builds up in arteries and restricts blood flow. The goal is to restore adequate blood flow through the affected artery, alleviate symptoms like leg pain, and reduce the risk of complications like ulcers or gangrene.

Indications

• Severe pain in the legs (claudication) due to blocked arteries
• Non-healing wounds or ulcers on the legs or feet
• Tissue death (gangrene) owing to poor blood flow
• Diagnostic tests showing significant artery blockage that cannot be managed with medication or less invasive procedures

Preparation

• Fasting for 6-8 hours before surgery
• Adjustment or temporary discontinuation of certain medications (e.g., blood thinners)
• Preoperative imaging studies like Doppler ultrasound, MRI, or CT angiography to assess the extent of artery blockage

Procedure Description

1. The patient is given general or regional anesthesia.
2. An incision is made over the affected artery.
3. The artery is exposed, and a clamp is placed to stop blood flow temporarily.
4. A small incision is made in the artery, and plaque is removed.
5. If required, a patch graft (often made from synthetic material or autologous vein) is sewn into the artery to widen it.
6. Blood flow is restored, and the incision is closed with sutures.
7. The surgical site is dressed appropriately.

Duration

The procedure typically takes 2-3 hours, depending on the complexity and the need for a patch graft.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Vascular surgeon
• Anesthesiologist
• Surgical nurses
• Possibly, a surgical technologist

Risks and Complications

• Infection at the surgical site
• Blood clots or bleeding
• Reaction to anesthesia
• Damage to surrounding nerves or tissues
• Re-narrowing of the artery (restenosis)
• Leg swelling

Benefits

• Improved blood flow and oxygen supply to the leg
• Relief from symptoms like pain and cramping
• Reduced risk of severe complications such as ulcers or gangrene
• Enhanced mobility and quality of life

Recovery

• Hospital stay of 1-2 days for monitoring
• Pain management with prescribed medications
• Avoiding strenuous activities for several weeks
• Follow-up appointments to check healing and blood flow
• Gradual return to normal activities as advised by the healthcare team

Alternatives

• Medication management (e.g., antiplatelet drugs, cholesterol-lowering agents)
• Angioplasty and stenting (less invasive, but may not be suitable for all patients)
• Bypass surgery (considered if multiple arteries are blocked)
• Lifestyle modifications such as exercise and smoking cessation

Patient Experience

• Patients may experience discomfort and soreness at the incision site.
• Pain is typically managed with medication.
• Some swelling in the leg is common but usually resolves with time.
• Gradual improvement in symptoms like leg pain and cramping can be expected.