Indications
- Acute limb ischaemia
Workup
- Coagulation screen
- Test foley catheter beforehand
Performed under LA/GA
Procedure
- Palpate femoral artery (mid inguinal point)
- Longitudinal incision over skin
- Deepen down to femoral artery
- Sling around CFA, SFA, Profunda
- Angled vascular clamp on each of three main vessels
- Transverse (risk of dissection) or Longitudinal (risk of stenosis) arteriotomy into femoral artery
- Pass catheter proximally up aortic bifurcation; inflate balloon (avoid overdistension - damages intima), withdraw any clot (assistant tightens tape to prevent bleeding)
- Send clot / embolus for histology - never know what is is!
- When good inflow, inject heparinized saline up vessel + reapply clamp
- If unable to achieve good back bleeding - do on-table angiogram
- If unable to achieve good inflow - get help
- Repeat on SFA, PFA
- Repair arteriotomy (5/O non-absorbable)
- Remove clamps, tapes, check haemostasis
- Insert suction drain
- Close wound
- Check + document pulse / clinical condition of limb
Complications
- Dissection
- Perforation of vessel
- Amputation