Femoral embolectomy

Why are we operating?

The six-hour operation: open the femoral artery, trawl the clot out with a balloon catheter, and give the leg its blood back before the muscle gives up.

Indication: Acute embolic limb ischaemia; the classically cold, pale, pulseless leg with a source in the heart.

The operation in 4 steps

1. 01Exposing the femoral bifurcation

   Vertical groin incision; common, superficial and profunda femoris arteries are exposed and slung.

2. 02Arteriotomy and catheter passes

   Heparin, clamps, a short arteriotomy, then a balloon embolectomy catheter is passed up and down, inflated, and withdrawn with the clot until back-bleeding and inflow return.

3. 03Closure and reperfusion

   The arteriotomy is closed transversely or with a patch, clamps released in sequence, and the foot reassessed.

4. 04The fasciotomy question

   After prolonged ischaemia, calf compartments are assessed and fasciotomies performed at a low threshold.

Danger zones

• Femoral artery

  Every access, every anastomosis, every groin stab wound: this is the vessel in question.

• Femoral vein

  Immediately medial to the artery, the structure a misplaced arterial puncture finds, and the wall of the femoral canal.

• Femoral nerve

  Lateral and OUTSIDE the femoral sheath; retractor injury costs knee extension.

Anatomy you need

The femoral artery at the groin and its run-off: where a saddle embolus lodges and where the catheter must reach.

What can go wrong

• Postoperative bleeding

  Tachycardia first, hypotension late; falling urine output; a distending abdomen or rising drain output.

• Venous thromboembolism

  Unilateral leg swelling, or sudden dyspnoea, pleuritic pain, tachycardia, sometimes the only sign is unexplained hypoxia.

• Surgical-site infection

  Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.