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Endarterectomy

Lower Limb Endarterectomy and Patch Surgery

If the artery at the top of the leg called the Common Femoral Artery has a blockage or severe narrowing, it may be necessary to perform an Endarterectomy and Patch. This operation involves clearing out the atheroma which is causing the narrowing and then repairing the artery with a patch to make it slightly wider than before. The patch is usually vein taken from the leg locally. As the body has many veins, using small lengths of vein in this was causes no impediment. Occasionally, a prosthetic patch is used.
Endarterectomy
In the work-up for the bypass it is usually to have an angiogram to make the diagnosis but also to plan the surgery carefully. It is also usually to have an ultrasound of the veins of the arm and leg to plan which conduit can be used. A medical workup and routine blood tests will be performed

The operation can be performed under general anaesthetic or spinal anaesthetic and there are several factors in deciding this and your anaesthetist will discuss this with you.

After the anaesthetic, an incision is made in the groin/top of the leg. Occasionally, a separate incision is made over the vein to be used as the patch. Through this incision the diseased artery is dissected out as are the artery above and arteries below the disease. The vein to be used as a patch is also exposed. A blood thinner called heparin is administered and the arteries above and below clamped. A longitudinal incision is made from normal vessel above, through the diseased artery into normal vessel below. The inner layers of the diseased artery which contain the atheroma are then carefully removed – this process is called endarterectomy. The artery is then repaired with a patch sutured into position. The arteries are thoroughly flushed and flow checked before completion. A drain usually placed and the wound closed in multiple layers.

Post-operatively the leg and wounds will be carefully observed in the ward. Routine post anaesthetic care including antibiotics and pain relief will be administered. Usually, you will be sitting out of bed the next day, and walking in 1 to 2 days. The usual hospital stay is between 3 and 7 days.

Most endarterectomy operations go well but there are some potential complications including anaesthetic related complications, bleeding, infection, low blood count requiring transfusion and blockage of the femoral artery. Occasionally a collection of clear fluid can occur called a lymphocoele. Uncommonly, a repeat unplanned operation may be required.

To learn more, please click here to view Information Sheet.