Difference between revisions of "Femoral artery endarterectomy"
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=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
* A-line is always required for frequent ACT draws plus BP management | |||
* 1-2 18G PIVs | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
* GA with ETT due to need for muscle relaxation | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
* Supine with arms tucked. C-arm or other fluoro device will be present and obstructing access to patient at times. | |||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
* Muscle relaxation is usually required | |||
* Heparin should be available and drawn up, as well as syringes for drawing ACTs | |||
** Protamine should be available but may not always be given. | |||
* BP should be maintained close to patient's baseline, but always check with the surgeon | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
* Avoid hypertension with emergence, which may challenge the new graft and incision. Have downers available to treat temporary HTN, such as labetalol. | |||
== Postoperative management == | == Postoperative management == | ||
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | === Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | ||
* Usually PACU > floor, patients stay 1-2 nights in the hospital | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
* Hemorrhage, stroke (embolization due to plaque rupture), groin hematoma | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
Latest revision as of 08:07, 20 July 2022
Femoral artery endarterectomy
| Anesthesia type |
GA |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV x1-2, radial a-line (to draw frequent ACTs and monitor BP) |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
Have lead available for frequent imaging. Have heparin available and small syringes for ACTs |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A femoral endarterectomy is a procedure with the goal of restoring patency to an occluded femoral artery and restoring vascular supply to the tissue. It involves a groin incision where the surgeon directly opens the femoral artery and removes the plaque, then closes the artery, at times with a synthetic patch.
Overview
Indications
Partial or total occlusion of the femoral artery from atherosclerosis and/or PAD.
Surgical procedure
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | Most of these patients have significant PAD. Many of these patients have comorbid CAD, HTN |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
- A-line is always required for frequent ACT draws plus BP management
- 1-2 18G PIVs
Induction and airway management
- GA with ETT due to need for muscle relaxation
Positioning
- Supine with arms tucked. C-arm or other fluoro device will be present and obstructing access to patient at times.
Maintenance and surgical considerations
- Muscle relaxation is usually required
- Heparin should be available and drawn up, as well as syringes for drawing ACTs
- Protamine should be available but may not always be given.
- BP should be maintained close to patient's baseline, but always check with the surgeon
Emergence
- Avoid hypertension with emergence, which may challenge the new graft and incision. Have downers available to treat temporary HTN, such as labetalol.
Postoperative management
Disposition
- Usually PACU > floor, patients stay 1-2 nights in the hospital
Pain management
Potential complications
- Hemorrhage, stroke (embolization due to plaque rupture), groin hematoma
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |