Femoral artery endarterectomy
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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 |