37618 Ligation, major artery (eg, post-traumatic, rupture); extremity

Name of the Procedure:

Ligation, major artery (e.g., post-traumatic, rupture); extremity

Summary

Ligation of a major artery in the extremity is a surgical procedure to tie off a ruptured or severely damaged artery, thereby stopping blood flow through that vessel. This is often done in emergency situations to control severe bleeding.

Purpose

The procedure is primarily performed to control life-threatening hemorrhage due to trauma or arterial rupture in an extremity. The goal is to prevent excessive blood loss and to stabilize the patient's condition.

Indications

• Severe trauma resulting in major arterial bleeding in an extremity
• Rupture of a major artery due to injury or aneurysm
• Inability to repair the artery using less invasive techniques
• Hemodynamic instability requiring immediate intervention

Preparation

• Fasting for at least 6 hours before surgery
• Adjustment or cessation of certain medications, such as blood thinners, as directed by the physician
• Pre-operative diagnostic tests including blood work, imaging studies (e.g., ultrasound, CT scan), and possibly a vascular consultation
• Informed consent explaining risks, benefits, and potential alternatives

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgical area is sterilized and draped.
3. An incision is made over the site of the damaged artery.
4. The artery is carefully identified and isolated.
5. Surgical instruments such as clamps and sutures are used to ligate (tie off) the artery.
6. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity and location of the injury.

Setting

The procedure is usually performed in a hospital operating room.

Personnel

• Surgeons specialized in vascular or trauma surgery
• Anesthesiologists
• Surgical nurses and technicians
• Possibly, a surgical assistant or resident

Risks and Complications

• Infection at the incision site
• Blood clots or deep vein thrombosis
• Ischemia (inadequate blood supply) to the extremity
• Nerve damage or loss of limb function
• Recurrent bleeding or hematoma
• Adverse reactions to anesthesia

Benefits

• Immediate control of severe bleeding
• Stabilization of the patient’s condition
• Prevention of further complications or death due to blood loss
• Potential for limb salvage if performed timely

Recovery

• Hospital stay for several days for monitoring
• Pain management with medications
• Gradual resumption of activity, avoiding strenuous movements for a few weeks
• Follow-up appointments for wound care and to monitor healing
• Physical therapy may be necessary if prolonged immobilization occurred

Alternatives

• Endovascular techniques, such as stenting or coiling, if the situation permits
• Non-surgical methods like compression or tourniquets which are typically temporary measures
• Each alternative has its own set of risks and benefits, often balanced against the urgency and the patient’s overall condition

Patient Experience

During the procedure, the patient will be under general anesthesia and thus will be unconscious and feel no pain. Post-operatively, the patient may experience pain or discomfort at the incision site, which can be managed with prescribed pain relievers. Swelling and bruising are common but should subside with time. The healthcare team will provide measures to ensure comfort and proper recovery, including pain management and mobility support as needed.