Name of the Procedure:

Thromboendarterectomy, including patch graft if performed; Iliofemoral

Summary

Thromboendarterectomy is a surgical procedure designed to remove a blockage or clot from the arteries, specifically targeting the iliofemoral artery, which supplies blood to the lower limbs. It often includes the placement of a patch graft to ensure proper blood flow.

Purpose

The procedure addresses significant blockages in the iliofemoral artery, typically caused by atherosclerosis or thrombosis. The goal is to restore adequate blood flow to the lower extremities, reducing symptoms like pain and improving mobility and overall limb health.

Indications

• Claudication (pain and cramping in the legs due to poor blood flow)
• Critical limb ischemia (severe obstruction of the arteries reducing blood flow to the extremities)
• Non-healing wounds or ulcers on the legs
• Significant iliofemoral artery blockage confirmed by diagnostic tests

Preparation

• Patients are usually required to fast (no food or drink) for 8-12 hours before surgery.
• Adjustments to current medications, particularly blood thinners, may be necessary.
• Preoperative tests such as blood work, an EKG, and imaging studies (e.g., CT angiography or Doppler ultrasound) are conducted.
• Patients may need to undergo a physical exam and medical history review.

Procedure Description

1. The patient is placed under general or regional anesthesia.
2. An incision is made near the groin to access the iliofemoral artery.
3. The artery is opened, and the blockage (thrombus or plaque) is removed.
4. A patch graft, typically made from synthetic material or vein tissue, is sewn onto the artery to widen it and ensure smooth blood flow.
5. The incision is closed with sutures, and a sterile dressing is applied.

Duration

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

Setting

Thromboendarterectomy is performed in a hospital surgical suite.

Personnel

• Vascular surgeon
• Anesthesiologist
• Operating room nurses
• Surgical technologists

Risks and Complications

• Bleeding
• Infection
• Blood clots
• Damage to surrounding structures
• Re-narrowing of the artery (restenosis)
• Reaction to anesthesia

Benefits

• Improved blood flow to the lower limbs
• Reduced pain and symptoms associated with poor circulation
• Enhanced ability to heal wounds and ulcers
• Increased mobility and quality of life

Recovery

• Patients typically stay in the hospital for 2-3 days post-surgery.
• Pain management includes medications as prescribed.
• Instructions may include limited physical activity, wound care, and follow-up visits for monitoring.
• Full recovery can take several weeks, with gradual resumption of daily activities.

Alternatives

• Medical management with medications (e.g., blood thinners, cholesterol-lowering drugs)
• Minimally invasive procedures like angioplasty with stent placement
• In some cases, bypass surgery

Each alternative has its own benefits and risks. Medical management is less invasive but may be less effective in severe cases. Angioplasty is less invasive but might not be suitable for all patients. Bypass surgery is more invasive but can be an option when less invasive techniques fail.

Patient Experience

• During the procedure, the patient will be under anesthesia and not feel pain.
• Post-surgery, discomfort and pain at the incision site are managed with medications.
• Mobility may be limited initially, requiring assistance.
• Patients might experience fatigue and need rest during recovery.
• Follow-up visits will ensure proper healing and assess the success of the procedure.

Overall, patients are often able to return to their normal activities gradually, with significant improvement in symptoms.