Femoral artery endarterectomy
|Lines and access||
PIV x1-2, radial a-line (to draw frequent ACTs and monitor BP)
|Primary anesthetic considerations|
Have lead available for frequent imaging. Have heparin available and small syringes for ACTs
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.
Partial or total occlusion of the femoral artery from atherosclerosis and/or PAD.
|Cardiovascular||Most of these patients have significant PAD. Many of these patients have comorbid CAD, HTN|
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
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
- 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
- Avoid hypertension with emergence, which may challenge the new graft and incision. Have downers available to treat temporary HTN, such as labetalol.
- Usually PACU > floor, patients stay 1-2 nights in the hospital
- Hemorrhage, stroke (embolization due to plaque rupture), groin hematoma
|Variant 1||Variant 2|