Name of the Procedure:

Thromboendarterectomy, including patch graft, if performed; common femoral

Summary

A thromboendarterectomy of the common femoral artery is a surgical procedure in which a blockage caused by plaque is removed from the artery. This procedure often involves a patch graft, which is a piece of material used to widen the artery and ensure proper blood flow.

Purpose

Medical Condition:

• Peripheral arterial disease (PAD)
• Chronic limb ischemia ##### Goals:
• Restore proper blood flow
• Relieve symptoms such as leg pain or cramping
• Improve mobility and overall quality of life
• Prevent further complications like tissue loss or amputation

Indications

Symptoms:

• Severe leg pain while walking or at rest
• Non-healing wounds or ulcers on the lower extremities
• Noticeable decrease in temperature of one leg compared to the other ##### Patient Criteria:
• Diagnosis of significant arterial blockage via imaging tests
• Poor response to non-surgical treatments

Preparation

• Fasting for 8-12 hours prior to the procedure
• Adjustment or discontinuation of certain medications (e.g., blood thinners)
• Preoperative blood tests and imaging, such as Doppler ultrasound or angiography

Procedure Description

1. The patient is given general or regional anesthesia.
2. An incision is made over the common femoral artery.
3. The artery is carefully opened, and the atherosclerotic plaque causing the blockage is removed.
4. A patch graft, typically made of synthetic material or vein from the patient, is sewn into place to widen the artery.
5. The incision is closed, and the patient is monitored in the recovery area.

Tools and Equipment:

• Scalpel
• Surgical clamps
• Synthetic or vein patch graft material
• Sutures and surgical staples

Anesthesia:

• General anesthesia or regional anesthesia (e.g., epidural or spinal)

Duration

The procedure typically takes about 2-3 hours.

Setting

Performed in a hospital operating room.

Personnel

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

Risks and Complications

Common Risks:

• Bleeding
• Infection at the incision site ##### Rare Complications:
• Blood clots
• Damage to the artery or surrounding tissues
• Kidney issues due to contrast dye used in prior imaging ##### Management: Immediate medical attention to address complications

Benefits

• Improved blood flow to the leg
• Relief from pain
• Enhanced mobility and functionality
• Reduced risk of ulcers, infections, and amputations ##### Realization: Benefits are often noticeable within a few days to weeks following the procedure.

Recovery

• Initial hospital stay of 1-3 days
• Gradual increase in physical activity
• Pain management with prescribed medications
• Instructions to avoid heavy lifting or strenuous activities for several weeks
• Follow-up appointments to monitor healing and blood flow

Alternatives

• Angioplasty and stenting: Less invasive, suitable for less severe blockages
• Medications: Limited effectiveness for severe cases
• Lifestyle changes: Often used in conjunction with other treatments

Pros and Cons of Alternatives:

• Angioplasty/stenting: Faster recovery, but less effective for complex blockages
• Medications: Non-invasive, but may not sufficiently relieve symptoms
• Lifestyle changes: Preventive, but not a cure for existing severe blockages

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-procedure, there may be some discomfort and soreness at the incision site, which can be managed with pain medications. The patient may experience some fatigue and limited mobility initially but should see progressive improvement over several weeks.