Femoral Arterial Thromboembolectomy

A femoral thromboembolectomy removes a clot that has suddenly blocked the femoral artery. Most often the clot (embolus) breaks off inside the heart, for example in a patient with atrial fibrillation or after a heart attack, and lodges where the artery divides in the groin. The leg becomes painful, numb, pale and pulseless, so the case is usually urgent. The surgeon opens the common femoral artery and draws the clot out with a balloon-tipped (Fogarty) catheter to restore flow to the leg. The approach is a short vertical groin incision. Because many of these patients are very sick, the surgery is often done under local anesthesia with a limited incision when possible, although general anesthesia may be used. Clot-dissolving drugs given through a catheter and catheter-based suction devices are alternatives, but open surgery remains the standard. If the catheter passes do not restore good flow, the surgeon may go on to a bypass. The same open technique with a Fogarty catheter was once used for clots in the deep veins, but that is now rarely done. The main risks are bleeding, damage or spasm of the artery, and clot that is left behind. Heparinized saline, several catheter sizes, two working suctions and a loaded sponge stick should be ready before the incision, and the team should be prepared for an angiogram on the table.