General Surgery

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What Is It ?

The main artery running down your bad leg is blocked near the knee. The leg is starved of blood. This causes pain, infection and even loss of the limb. The blockage in the artery is because of a blood clot. This has formed in the artery, or has floated down in the bloodstream from your heart or another blood vessel upstream. The loose type of blood clot is called an embolus. Either way, it is essential to try and get the blood clot out. Taking out the clot is called an embolectomy. If the clot came from upstream, and the leg is healthy, the operation usually works very well. If not, the artery may well clot up again, and the leg is at risk of getting worse. You may need special tests and possibly bigger operations. As a first step, the embolectomy is absolutely necessary to save your leg.

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Before The Operation

You will have come to the hospital as an emergency. Check that you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to the hospital with you.

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On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form.

The Operation

You may have a general anaesthetic and be asleep for the whole operation, or have an injection in your back, (epidural) or groin and be heavily sedated. Either way you will not remember anything about the operation. A cut is made into the skin in the groin and thigh. Sometimes a cut is made on each side to catch any clot slipping into the artery of the other leg. The artery is opened. Then a special plastic balloon is slid down the artery. The clot is then pulled out through the opening in the artery.

The opening in the artery is stitched up. The surgeon checks the blood is flowing down the artery once more. Finally the skin is stitched up. If the operation is not done soon after the blocking (occlusion) of the artery it might be that the surgeon will have to make a couple of cuts on the skin and the underling fat and supportive tissue (fascia) on each side of your leg below the knee. The cuts are called fasciotomies. This is done because the leg gets very swollen when the blood flows through it again (perfusion) after a long time of non-perfusion. The swelling can compress the tissues of the leg to the point that it will destroy them. The fasciotomies release the pressure and allow the leg to recover. In most cases, the fasciotomies heal on their own relatively quickly and the areas of the cuts are covered again with skin. You should plan to leave the hospital about five to seven days after the operation provided the leg is healthy. If you have fasciotomies you might need to stay longer.

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Possible Complications

If you have this operation under general anaesthetic, there is a risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will reduce the chances for such complications.

If you have an anaesthetic injection in the back, there is a very small chance of a blood clot forming on top of your spine which can cause numbness or pins and needles in your legs. The clot usually dissolves on its own and this solves the problem. Extremely rarely, the injections can cause permanent damage to your spine.

It is important to know that the chances of dying during or after a femoral embolectomy can be up to 25% especially if you are elderly and you have a serious cardiac disease.

Complications are rapidly recognised and dealt with by the surgical staff. If you think that all is not well, please let the doctors and nurses know.

Sometimes there is some bleeding under the wounds which causes more severe bruising. This usually settles down. It is possible to have more bleeding in the area of the operation and this may require another operation to stop it. The fact that you are going to be given blood thinners increases the chances of bleeding after the operation.

Sometimes the blood in the artery clots. This usually needs a second operation to clear the blockage. The next steps to deal with this will be discussed with you. Wound infection is sometimes seen. This settles down with antibiotics in a week or two. Sometimes fluid builds up under the wounds. This settles down.

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