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.

   Why: Control above and below before the artery is opened is the first law of vascular surgery; the femoral triangle's constant anatomy is why this operation can be fast when it must be.

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   Heparin, clamps, a short arteriotomy, then a balloon embolectomy catheter is passed up and down, inflated, and withdrawn with the clot until back-bleeding and inflow return.

   Why: The balloon does the surgery: passed beyond the clot deflated, drawn back inflated, it delivers the embolus in casts. Good inflow from above and back-bleeding from below are the operation's proof of patency, and the catheter's gentleness is what keeps the intima intact.

3. 03Closure and reperfusion

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

   Why: Transverse closure resists narrowing a vessel that has already been ischaemic once today. The leg's colour and signal returning on the table is the operation's real endpoint.

4. 04The fasciotomy question

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

   Why: Reperfused muscle swells inside fascial boxes that do not stretch; compartment syndrome after revascularisation is predictable, and prophylactic fasciotomy is cheaper than a missed one. The heart that threw the clot is the next consultation.

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.