Name of the Procedure:

Thromboendarterectomy, including patch graft, if performed; mesenteric, celiac, or renal

Summary

Thromboendarterectomy is a surgical procedure to remove a blood clot or plaque from an artery. It often includes the use of a patch graft to repair and widen the artery. This procedure is typically performed on mesenteric, celiac, or renal arteries that supply blood to the intestines, liver, and kidneys, respectively.

Purpose

The procedure addresses narrowed or blocked arteries caused by blood clots or a buildup of plaque, which can lead to insufficient blood flow to vital organs. The primary goal is to restore adequate blood flow, thereby preventing organ damage and improving overall organ function.

Indications

• Symptoms of severe abdominal pain after eating (abdominal angina)
• Uncontrolled hypertension due to renal artery stenosis
• Chronic mesenteric ischemia
• Vascular conditions compromising blood flow to the liver or intestines
• Acute mesenteric artery occlusion

Preparation

• Patients may need to fast for 6-8 hours before the procedure.
• Adjustment of certain medications, including blood thinners.
• Pre-procedure diagnostic tests like ultrasound, CT angiography, or MR angiography to evaluate the extent and location of the blockage.
• Assessment of overall health and anesthesia risk.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A surgical incision is made near the affected artery.
3. Identifying the Blockage: The artery is exposed and the blockage is located.
4. Removal of Blockage: The clot or plaque causing the blockage is carefully removed.
5. Patch Graft: If necessary, a patch graft made of synthetic material or vein is sewn into the artery to widen it and ensure smooth blood flow.
6. Closure: The incision is closed with sutures or staples.

Tools and Equipment

• Surgical instruments
• Synthetic patch graft or autologous vein graft
• Imaging tools for intraoperative guidance

Duration

The procedure typically takes between 2 to 4 hours.

Setting

Thromboendarterectomy is performed in a hospital operating room.

Personnel

• Vascular surgeon
• Surgical nurses
• Anesthesiologist
• Radiologic technologist for intraoperative imaging, if necessary

Risks and Complications

• Infection at the incision site
• Bleeding or blood clots
• Injury to surrounding tissues or organs
• Recurrence of artery blockage
• Possible reaction to anesthesia
• Kidney failure (especially in renal procedures)
• Bowel ischemia (especially in mesenteric procedures)

Benefits

• Improved blood flow to affected organs
• Relief from symptoms such as abdominal pain, and high blood pressure
• Reduced risk of organ damage
• Typically, benefits are noticed immediately after recovery from surgery

Recovery

• Postoperative monitoring in the hospital for a few days
• Pain management with prescribed medications
• Instructions to avoid strenuous activities and lifting heavy objects for a few weeks
• Follow-up appointments for wound inspection and overall recovery assessment
• Dietary adjustments and activity modifications as recommended

Alternatives

• Angioplasty with or without stenting
• Medical management with blood thinners and medications
• Bypass surgery
• Endovascular procedures
• Advantages of thromboendarterectomy include direct removal of blockage, while less invasive options like angioplasty may have shorter recovery times but could be less effective for complex blockages.

Patient Experience

• Patients will not feel anything during the procedure due to general anesthesia.
• Postoperatively, they might experience pain or discomfort at the incision site, managed with pain relievers.
• A brief hospital stay will be needed for monitoring and initial recovery.
• Gradual improvement in symptoms such as pain and blood flow-related issues can be expected within days to weeks.