Name of the Procedure:

Thromboendarterectomy, including patch graft, if performed; iliac

Summary

Thromboendarterectomy is a surgical procedure to remove a blood clot (thrombus) and the inner lining of the artery (endothelium) that has thickened, usually due to atherosclerosis, from the iliac artery. If necessary, a patch graft, typically from a synthetic material, is used to widen and repair the artery.

Purpose

This procedure addresses blocked or narrowed iliac arteries, which can impede blood flow to the lower extremities, causing pain and increasing the risk of more severe complications. The goal is to restore adequate blood flow and reduce symptoms such as leg pain and cramps, as well as improve mobility and quality of life.

Indications

• Severe peripheral arterial disease (PAD)
• Significant iliac artery stenosis or occlusion
• Symptoms like claudication (pain/cramping in the legs during exercise) or rest pain
• Non-healing wounds or ulcers on the lower extremities due to poor circulation
• Failed endovascular treatments like angioplasty or stenting

Preparation

• Fasting for a specified period before the surgery (usually 8 hours)
• Discontinuation of certain medications, especially blood thinners, as advised by the doctor
• Various diagnostic tests including ultrasound, CT angiography, or MR angiography to assess the extent of the arterial blockage

Procedure Description

1. The patient is administered general anesthesia.
2. A surgical incision is made in the abdomen or groin to access the iliac artery.
3. The surgeon carefully opens the artery and removes the blood clot and the thickened arterial lining.
4. If necessary, a patch graft is applied to widen the artery and ensure smooth blood flow.
5. The artery and incision site are closed.
6. The procedure may require a catheter or shunt to maintain blood flow during surgery.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity.

Setting

Thromboendarterectomy is performed in a hospital setting, specifically in an operating room equipped for vascular surgeries.

Personnel

• Vascular surgeon
• Anesthesiologist
• Surgical nurses
• Scrub technicians

Risks and Complications

• Bleeding or hematoma formation
• Infection at the incision site
• Blood clots
• Injury to the nearby nerves or blood vessels
• Complications from anesthesia
• Re-narrowing (restenosis) of the artery

Benefits

• Restored blood flow to the lower extremities
• Reduced pain and cramping in the legs
• Improved ability to walk and perform daily activities
• Lowered risk of limb loss from severe PAD

Recovery

• Immediate post-operative care includes monitoring in a recovery room.
• Hospital stay is usually around 2 to 3 days.
• Instructions include wound care, activity restrictions, and pain management.
• Follow-up appointments are required to monitor healing and arterial flow.
• Full recovery may take several weeks, with gradual resumption of normal activities.

Alternatives

• Endovascular procedures such as angioplasty with stenting
• Bypass surgery, where a graft is used to redirect blood flow around the blocked artery
• Medical management, including medication and lifestyle changes (less invasive but may be less effective in severe cases)

Patient Experience

During the procedure, the patient is under general anesthesia and unaware of the surgery. Post-procedure, the patient may experience soreness at the incision site, manageable with prescribed pain medication. Mobilization is encouraged as soon as possible to aid recovery. Regular check-ups ensure the success of the procedure and overall well-being.