Femoral Embolectomy

1.Position the patient supine.
2.Prepare the entire limb on the involved side only.
3.Make a vertical incision over the mid-inguinal point and insert a self-retaining retractor (Weitlander).
4.Dissect down to the femoral artery/profunda trifurcation. Administer 5000u of heparin and then encircle the vessels with vascular slings.
5.Make a longitudinal arteriotomy at the trifurcation with a clamp on the patent vessels.
6.Insert a Fogarty balloon catheter (size 4 or 4mm calibre) and perform an antegrade embolectomy to beyond the popliteal trifurcation if possible. If there is an occlusion beyond which the catheter will not pass it may be at the adductor hiatus (try again with the tip bent) or because of atheroma. Similarly, perform a retrograde embolectomy (using a size 5 catheter).
7.Remove clot ahead of the embolectomy balloon with a vascular sucker, with a right angled clamp at the ready. If there is steady back bleeding, conclude the embolectomy.
8.Perform an on-table angiogram to determine patency of vessels.
9.If flow is still inadequate leave a catheter in situ for a urokinase infusion.
10.Close the arteriotomy with double armed 4/0 prolene.
11.Close wound in layers.