Consent: Embolectomy - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent. Overview of Procedure An embolectomy is undertaken due to an acute arterial occlusion, causing acute limb ischaemia. This can be achieved through access in any artery, however it is most common in the brachial or femoral region. Following arterial dissection, a balloon catheter is inserted into the artery and passed beyond the occlusion, to then be inflated and withdrawn back to pull out any embolus. This is done until no further clot is retrieved and the arteriotomy is closed. Complications Intraoperative Complication Description of Complication Potential Ways to Reduce Risk Haemorrhage This can occur due to damage to either the artery or the femoral vein or its branches and may require blood transfusion. Injury to surrounding structures including femoral nerve or vein The femoral artery lies between the femoral nerve and femoral vein. Either of these can be damaged during the dissection if not careful. Dissect using a standard approach with identification of the inguinal ligament primarily, then approach the artery proximally Anaesthetic Risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation Early Complication Description of Complication Potential Ways to Reduce Risk Pain The patient will most likely have an epidural to minimise this or use of local anaesthesia during the procedure. Bleeding There is a small chance of bleeding and bruising in the groin post-surgery. Infection Superficial wound infection is possible, and most common in the groin, however dissection infection if occurs is a major complication requiring life-long antibiotics. Peri-operative antibiotics will reduce the risk of wound infections Scarring A longitudinal or transverse incisions will result in a scar, which may form a keloid scar, particular in high risk ethnicities. Seroma A swelling of lymphatic fluid may occur due to disruption of the lymph nodes and channels. Careful dissection of the lymphatic nodes and channels with ligation will minimise this risk. Blood clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate. Compartment syndrome Compartment syndrome may occur in patients with prolonged clamp times or in the acute setting. Patients with a long history of peripheral vascular disease are preconditioned for ischaemia so it is less likely. Minimise clamp times Stroke, MI, Kkdney failure, death Although small, this is always a risk in any major surgery Late Complication Description of Complication Potential Ways to Reduce Risk Hernia Any groin incision can cause a hernia if there is damage to the inguinal ligament or extensive lifting of the ligament during the procedure. Reintervention Any acute arterial occlusion may reoccur due to stenosis of the vessel or further emboli from the proximal source. Ensure adequate anticoagulation post-operatively Frequent questions What is an embolectomy? An embolectomy is a surgical procedure performed to remove an embolus causing acute arterial occlusion and limb ischaemia. It typically involves accessing the artery, often in the brachial or femoral region, to retrieve the clot using a balloon catheter. What are the common complications associated with embolectomy? Common complications during an embolectomy include haemorrhage, injury to surrounding structures, and anaesthetic risks. Post-operative complications may involve pain, bleeding, infection, scarring, and the risk of blood clots. How can the risk of haemorrhage be minimised during an embolectomy? To reduce the risk of haemorrhage during an embolectomy, careful dissection is essential to avoid damaging the artery or femoral vein. Identifying the inguinal ligament and approaching the artery proximally can also help mitigate this risk. What measures are taken to prevent infection after embolectomy? To minimise the risk of infection following an embolectomy, peri-operative antibiotics are administered. This is particularly important to prevent superficial wound infections, especially in the groin area. What post-operative care is important to avoid complications like DVT after embolectomy? Post-operative care for preventing deep vein thrombosis (DVT) includes the use of anti-embolism stockings and administering low molecular weight heparin as appropriate. This is especially crucial for patients with risk factors such as a high BMI or recent travel. Rate This Article