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Geoffrey asked...

I am due to have an operation

Tags: arteries

I am due to have an operation for femoral artery endarterectomy in November. I am diabetic and am almost 77 years old .i have not yet been to the pre-assessment meeting where I know I can ask questions. I do not smoke but do regularly drink mainly spirits. I have not been able to walk far for some years now . Some of the sites I have visited in google have indicated that there is a relatively high mortality rate in my group one says 3.4 percent another 14 percent and another says that there is a 16 percent chance of cardiac problems. Obviously this is a concern but I would greatly appreciate your views as to wether or not I should take the risk.

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The answer

Hello Geoffrey and thank you for writing in to Ask the Expert.

In this response we will endeavour to tell you a bit about the procedure, why it is done, how it is done and the risks and benefits. We will refer to recommendations by the National Institute for Health and Care Excellence (NICE) and, also give you information from other sites which will hopefully help you with your decision making in conjunction with the information you will receive from your Surgeon at your next consultation.

A femoral artery endarterectomy is a surgical procedure which is performed in order to remove fatty deposits which are narrowing the femoral artery.

The build up of fatty deposits in the arteries of your legs is also known as peripheral vascular disease.

When the arteries of your legs become blocked, the blood circulation to the legs are affected and this can cause pain, difficulty with walking and in severe cases the onset of gangrene.

The purpose of this procedure is to remove the blockages and in some cases widen any narrowed arteries so that ideally circulation to the legs and feet are improved or restored therefore improving your walking capabilities and health.

The methodology of the procedure is that by making an incision in your groin area, access to the femoral artery can be gained and then the removing of fatty deposits can be undertaken. An angioplasty balloon may then be used to help widen any narrow arteries too. A patch is then inserted to help prevent the blockages occurring again in the future. Stitches are generally used to close the wound.

The procedure will be done under a general anaesthetic or under epidural anaesthesia depending on your health, personal/ Surgeon preference and amount of work needed to be done.

As with all operations there are risks, and as you have found whilst doing your own research, varying degrees of information available re mortality rates. The mortality rates are usually based on all procedures performed and all the risks but also include data on pre- existing risk factors that can complicate treatment.

NICE recommend this procedure as a gold standard practice where there is peripheral vascular disease as often the benefits outweigh the risks to individuals. Research has also shown that this type of surgery often improves outcome for people and can actually extend your life by reducing the effects of the peripheral vascular disease.

The benefits of the operation are that it may well improve your mobility and reduce pain by improving the blood flow to your legs.

The risks of any operation are infection and blood loss but for this procedure may include swelling of the leg, skin numbness because of nerve damage and clots/ fatty deposits moving further into the arteries or body.

Risks in relation to surgery can also be affected by pre- existing medical conditions like diabetes and heart disease as well as lifestyle choices such as being overweight or smoking.

In order to improve the outcome and on-going success of the operation, making changes to diet, alcohol, and smoking intake, maintaining your blood sugar levels at a good level and exercising where possible would be encouraged.

You mention that you do not smoke so this is a positive factor towards the success of the procedure.

In relation to your diabetes, if this is well controlled then this will also help you with your recovery.

Regarding alcohol or medication use this may need to be reduced or stopped prior to the operation due to the way the blood can be affected e.g. thinned and the surgeon should advise you of any precautions needed. Again making sure you follow pre-operative preparation advice will help you too.

When you have your pre- assessment appointment it would be wise to make sure that you write down any questions you have and the answers given you as this will help you with your understanding and also enable your concerns to be dealt with appropriately.

Your surgeon will only proceed with the operation if they feel that you will benefit from it and are well enough to proceed with it too. The surgeon and anaesthetist will ensure that treatment and medications given are appropriate and will cause minimal insult to your body too.

Sites used to help answer your question were:

www.nice.org.uk

www.guysandstthomas.nhs.uk/resources/patient-information/femoral-endarterectomy

www.nhs.uk/conditions/peripheralarterialdisease

We hope this helps answer your question and I wish you all the very best with your treatment, operation and recovery.

Answered by the Health at Hand nurses  

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