Remote Superficial Femoral Artery Endarterectomy

WHAT YOU SHOULD KNOW:

• Remote superficial femoral artery endarterectomy (RSFAE) is a procedure to remove plaques inside the superficial femoral artery (SFA). The femoral artery is the main blood vessel in your thigh that carries blood and oxygen to the legs. Plaques are fat, cholesterol, or tissues that are clogged in the inner wall of the artery. When plaques build up inside the superficial femoral artery, blood flow to the legs may be decreased. RSFAE may be done to relieve problems caused by a narrowed or blocked artery. Problems that may happen include severe pain in the hip, thigh, calf, or foot, and trouble when walking. Having these problems may decrease a person's ability to do his daily activities and affect his quality of life.
  
  
• With RSFAE, the plaque that blocks the artery is removed through a small incision (cut) in the groin. The groin is the area where your abdomen (stomach) meets your upper leg. Caregivers strip, cut, and remove the plaque by using different tools inserted through the SFA. This is done using a special type of x-ray as a guide. RSFAE may be followed by other procedures, such as angioplasty and stenting. Angioplasty opens the artery using a small, high pressure balloon. Stenting uses metal or plastic stents (tubes), in the area where the blockage was removed, to keep the artery open.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

Without treatment, your symptoms, such as leg pain, trouble walking, and tiring easily, may worsen. If parts of your leg do not get enough blood and oxygen, you may need an amputation (be removed). Your condition may also lead to a heart attack or stroke (brain attack). Problems with a RSFAE may include an infection, having trouble breathing, or getting a blood clot. Even after the procedure, the artery may become narrow again. The blood vessel used for the procedure may tear, causing a large amount of blood loss. Ask your caregiver if you are worried or have questions about your procedure, medicine, or care.

GETTING READY:

The week before your procedure:

• Ask a family member to drive you home after your procedure. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medicines. If you take aspirin, ibuprofen, or blood thinners, do not stop taking them without first asking your caregiver.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• Dye may be used during your procedure to let caregivers see the arteries better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
• If you are female, tell your caregiver if you know or think you might be pregnant.
  
  
• You may need to have blood tests, an electrocardiogram (ECG), chest x-ray, and other tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your procedure:

• Remove any nail polish.
  
  
• You may be given medicine to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The day of your procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Ask your caregiver before taking any medicine on the day of your procedure. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all medicines that you are taking, including the pill bottles, with you to the hospital.
  
  
• If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.
  
  
• Do not wear tight-fitting clothes on the day of your procedure or surgery.
  
  
• Caregivers will insert an intravenous (IV) tube into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your procedure. This caregiver may give you medicine to make you sleepy before your procedure. Tell your caregiver if you or any member of your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal piece of paper (informed consent). It gives your caregiver permission to do the procedure. It also explains the problems that may happen with the procedure, and your choices. Be sure all of your questions have been answered before you sign this form.

TREATMENT:

What will happen:

• You will be asked to change into a hospital gown. You may be given medicine to help you relax or make you drowsy. You will be taken on a stretcher to the room where the procedure will be done. X-rays with a TV screen will be used to guide caregivers during the procedure. You may be moved into a special bed. Caregivers will clean your skin and sheets will be put over you to keep the area clean. You will get medicine called anesthesia to numb the area where the procedure will be done.
  
  
• Caregivers will make a small incision in your groin to see the femoral artery. Dye may be put in the artery to make the blocked area show up better. Caregivers will then make a small incision in the SFA and use special tools to separate the plaque from the blood vessel wall. When the end of the artery blockage is reached, the plaque is cut and removed from the artery. Dye is again put into the artery and pictures are taken to make sure the plaque was completely removed. Angioplasty may then be done and a stent placed inside the artery. The incisions will be closed with sutures (threads) and covered with tight pressure bandages.

After your procedure: You may be transferred to a room after your procedure. You will need to lie flat in bed for a time. Keep your leg straight and do not move the leg where the RSFAE was done. Do not get out of bed until your caregiver says it is OK. Caregivers will watch you closely for any problems. When caregivers see that you are OK, you may be taken to your hospital room. The bandages used to cover your stitches will keep the area clean and dry to prevent infection. Caregivers may remove the bandage soon after the procedure to check the incision.

Waiting room: This is a room where your family and friends can wait until you are ready for visitors. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

• You cannot make it to your procedure appointment on time.
  
  
• You have a fever (increased body temperature).
  
  
• You have a wound near the area where the procedure will be done.
  
  
• You have questions or concerns about your procedure.

SEEK CARE IMMEDIATELY IF:

• You have signs of a heart attack:
  
  
  • Chest pain or discomfort that spreads to your arms, jaw, or back.
    
    
  • Unusual, sudden back pain.
    
    
  • Nausea (sick to your stomach).
    
    
  • Trouble breathing.
    
    
  • Sweating.
    
    
  • Lips or nailbeds that turn blue or white in color.
    
    
  • This is an emergency. Call 911 or 0 (operator) for an ambulance to get to the nearest hospital or clinic. Do not drive yourself!
  
  
• You have signs and symptoms of a stroke: You have one or more of these signs and symptoms of a stroke. These signs and symptoms may happen suddenly:
  
  
  • A very bad headache. This may feel like the worst headache of your life.
    
    
  • Too dizzy to stand.
    
    
  • Weakness or numbness in your arm, leg, or face. This may happen on only one side of your body.
    
    
  • Confusion and problems speaking or understanding things.
    
    
  • Not able to see out of one or both of your eyes.
    
    
  • This is an emergency. Call 911 or 0 (operator) for an ambulance to get to the nearest hospital. Do not drive yourself!

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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