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
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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

References