Name of the Procedure:

Thromboendarterectomy (TEA), including patch graft, if performed; axillary-brachial

Summary

Thromboendarterectomy (TEA) is a surgical procedure that removes plaque and blood clots from the artery walls. When performed on the axillary-brachial artery, it focuses on the arteries running from the shoulder to the elbow. Sometimes, a patch graft is used to widen the cleaned artery.

Purpose

This procedure is designed to address significant artery blockages, improving blood flow and reducing symptoms such as pain, numbness, or potential tissue damage due to inadequate blood supply.

Indications

• Severe atherosclerosis in the axillary or brachial arteries
• Symptoms like claudication (pain due to inadequate blood flow during exercise)
• Critical limb ischemia (severe blockage reducing blood flow to extremities)
• Failed medical management with medications or lifestyle changes

Preparation

• Fasting for 8-12 hours before surgery
• Stopping certain medications as instructed by the healthcare provider
• Pre-operative diagnostic tests like blood work, imaging studies (CT, MRI, or angiography), and a thorough physical examination

Procedure Description

1. The patient is positioned on the operating table, and general or regional anesthesia is administered.
2. The surgeon makes an incision over the affected axillary or brachial artery.
3. The artery is opened, and plaque or blood clots are carefully removed.
4. If necessary, a patch graft made from synthetic material or the patient’s own veins is used to widen the artery.
5. The artery and incision are then closed, and blood flow is checked to ensure it has been restored.
6. Sterile dressings are applied to the surgical site.

Duration

The procedure typically takes 2-3 hours.

Setting

This procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Vascular surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Blood clots or embolism
• Nerve injury leading to numbness or weakness
• Re-narrowing of the artery (restenosis)
• Reaction to anesthesia

Benefits

• Improved blood flow in the treated artery
• Reduction or elimination of symptoms like pain and numbness
• Prevention of tissue damage due to insufficient blood supply
• Enhanced quality of life and mobility

Recovery

• Hospital stay for 1-3 days post-procedure
• Pain management with prescribed medications
• Avoiding strenuous activities for several weeks
• Regular follow-up appointments to monitor recovery and blood flow
• Possible lifestyle changes to maintain artery health, including diet and exercise

Alternatives

• Medication management (antiplatelet agents, statins)
• Percutaneous transluminal angioplasty (PTA), sometimes with stent placement
• Bypass surgery
• Conservative management with lifestyle changes

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Postoperatively, there may be some discomfort or pain at the incision site, which can be managed with medications. Most patients can resume normal activities within a few weeks, though the specific timeline can vary.

Pain management and comfort measures will be provided to ensure a smooth recovery process.