37616 Ligation, major artery (eg, post-traumatic, rupture); chest

Name of the Procedure:

Ligation of a Major Artery in the Chest
Common Names: Arterial ligation, Major chest artery repair
Medical Terms: Arterial ligation for post-traumatic or rupture repair, Thoracic arterial ligation

Summary

Ligation of a major artery in the chest involves surgically tying off a damaged or ruptured artery to stop bleeding and restore stability. This procedure is typically performed in emergency situations following trauma or when an artery in the chest has ruptured.

Purpose

Medical Condition Addressed:

• Severe bleeding due to trauma or rupture of a major chest artery.

Goals:

• Control and stop life-threatening bleeding.
• Prevent further complications, such as hemorrhagic shock or death.
• Stabilize the patient for further surgical or medical treatment.

Indications

• Severe chest trauma causing arterial rupture.
• Spontaneous rupture of a major chest artery.
• Uncontrolled bleeding that cannot be managed by less invasive means.
• Patients showing symptoms of severe blood loss, such as low blood pressure, rapid pulse, or shock.

Preparation

• Pre-procedure fasting (usually for 8 hours prior) to reduce the risk of aspiration during anesthesia.
• Discontinuation of certain medications, such as blood thinners, prior to the procedure.
• Preoperative imaging studies (e.g., CT scan, angiography) to accurately locate the arterial damage.
• Blood typing and cross-matching in case of a need for transfusion.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A surgical incision is made in the chest to access the damaged artery.
3. Exposure: The surgeon carefully exposes and isolates the damaged artery.
4. Ligation: The artery is sutured and tied off to halt the bleeding.
5. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Tools and Equipment:

• Scalpel, clamps, surgical sutures, and ligation instruments.
• Imaging equipment for preoperative and intraoperative guidance.

Duration

Typically, the procedure takes around 2 to 4 hours, depending on the complexity and extent of the trauma.

Setting

This procedure is performed in a hospital's operating room, often as an emergency surgery.

Personnel

• Surgeons: Thoracic or vascular surgeons.
• Anesthesiologists: To manage anesthesia.
• Surgical Nurses: Assist with the procedure and provide postoperative care.
• Radiologists: May be involved for imaging guidance.

Risks and Complications

Common Risks:

• Infection at the surgical site
• Blood clots
• Bleeding

Rare Risks:

• Damage to nearby organs and tissues
• Respiratory complications
• Reaction to anesthesia

Complications Management:

• Antibiotics for infection
• Emergency interventions for severe complications

Benefits

• Rapid control of life-threatening bleeding.
• Stabilization of the patient's condition.
• Prevention of further complications from blood loss.

Recovery

• Post-Procedure Care: Monitoring in a hospital intensive care unit (ICU).
• Instructions: Gradual reintroduction of food and fluids, pain management, wound care.
• Recovery Time: Full recovery may take several weeks, with potential restrictions on physical activities.
• Follow-Up: Regular medical follow-ups for wound healing and overall recovery assessment.

Alternatives

• Endovascular repair: Less invasive but might not be suitable for all cases.
• Conservative management: Only feasible for less severe injuries.

Pros and Cons of Alternatives:

• Endovascular Repair: Less trauma and faster recovery but may not be suitable for complex injuries.
• Conservative Management: Avoids surgery but carries a higher risk of uncontrolled bleeding.

Patient Experience

During the Procedure:

• Under general anesthesia, the patient will be unconscious and feel no pain.

After the Procedure:

• Hospital stay for monitoring, typically in the ICU.
• Some discomfort and pain managed with medications.
• Possible temporary restrictions on physical activity.
• Frequent follow-up visits to ensure proper healing and functionality.

## Pain Management:

Pain relief is typically managed with medications, including opioids for severe pain and non-opioid analgesics for moderate discomfort.