Overview

Atherosclerosis is the build-up of fatty deposits (atheroma) in the wall of the arteries. When this happens in the legs, it is called peripheral arterial disease.

The narrowing, or even blockage, of the arteries in the legs can cause different problems depending on how severe it is. Some patients have no symptoms, but others get pain when they exercise (intermittent claudication). If the circulation to the leg gets even worse, persistent pain might be felt in the foot, and can cause gangrene.

One way to improve the circulation to the legs is to have a femoral endarterectomy. This is when we surgically remove the atheroma that is causing the narrowing or blockage. This works best when the length of the narrowing or blockage is quite short, and is usually done on the femoral artery in the groin.

There might be other short narrowings or blockages of the arteries in the thigh or pelvis. These might be dilated (made wider) by balloon angioplasty, shortly before or during the operation on the groin.

Benefits of a femoral endarterectomy

This operation should allow you to walk further, and without pain.

Risks of a femoral endarterectomy

Although a femoral endarterectomy is a smaller operation than major bypass surgery, it is still major surgery and a few patients have complications. The actual risk is different for each patient, and depends on other medical problems, such as heart, lung and kidney conditions.

Possible complications specific to a femoral endarterectomy include the following.

Haematoma and bleeding

Blood can collect under the skin after the procedure. If there is no ongoing bleeding, no treatment is needed. Occasionally, there may be heavy bleeding that doesn't stop, and this needs urgent surgery.

Leg swelling

This usually resolves by itself, but can take several months to settle. Elevating (raising) the leg when you’re sitting in a chair can help to reduce the swelling.

Skin numbness

You might have some numbness in some areas, because nerves are cut during surgery. At first this can be very noticeable, but it usually fades with time. In the longer term it is not normally a problem for most patients.

Wound infection

If you get a wound infection, it usually only needs antibiotics to treat it. Occasionally, the wound needs to be cleaned out under anaesthetic.

Loss of blood supply to the legs

This might happen because of the original blockage, or from dislodging loose material within the arteries that then passes down into the legs. This is rare but might need more surgery. Rarely, amputation is necessary.

Infection of the synthetic patch

This is rare, but usually means we need to remove the patch.

Read more about having an anaesthetic.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the procedure or treatment, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.

Read more about our consent process.

Preparing for surgery

You will come to hospital for your pre-assessment appointment. We will tell you how to prepare, and review your regular medicines.

If you are taking antiplatelet medicines (such as aspirin or clopidogrel), or any blood-thinning medicines (such as warfarin), you might need to stop them temporarily before the procedure.

If you are taking any medicines for diabetes (such as metformin) or using insulin, these might also need to be stopped temporarily, or the dose (amount) changed, near the time of the procedure. You will be given full information on any changes that you need to make to your medicines at the pre-assessment appointment. Please ask us if you have any questions.

You must fast (not eat or drink anything) for 6 hours before the surgery. We will give you clear instructions on exactly when to start fasting. It is important to follow these instructions. If there is food or liquid in your stomach during your operation, it could come up to the back of your throat and damage your lungs.

Please continue to take your regular medicines with a sip of water before 6am on the morning of the procedure, unless you have been told otherwise.

During a femoral endarterectomy

The surgery can be done under a general anaesthetic (a state of controlled unconsciousness) or an epidural anaesthetic (an injection in your back to make you go numb from the waist down). Your consultant and anaesthetist will talk to you about which sort of anaesthetic would be best for you.

A cut (incision) is made in your groin. The femoral artery is then cut open and the atheroma is removed.

An angioplasty balloon might be inserted using X-ray guidance, to stretch other narrowings in the arteries. This can be above the groin (in the pelvis), or below the groin (in the leg).

You might also have a stent (metal scaffold) put in your artery to keep it open.

The femoral artery is then closed by stitching in a patch of vein, or a synthetic (bovine) patch, to prevent it from narrowing more. Your consultant will explain more about the different patches before your operation.

The wound is then closed with stitches or metal clips. These will be removed about 10 days after surgery.

After the procedure

After the operation you will be taken to the recovery room where you’ll be monitored until you are awake enough to move to Sarah Swift ward or another cardiac (heart) ward.

You will be given fluids through a drip into a vein until you feel well enough to sit up to eat and drink normally.

Your mobility will be checked by a physiotherapist the morning after your operation. You can expect to stay in hospital for 2 days.

You will be given aspirin, which thins the blood. You will usually need to continue to take aspirin long term.

After you leave hospital

We will arrange for your GP’s practice nurse or a district nurse to remove your stitches or clips, if necessary.

Your dressing will usually be removed before you leave hospital. If you still need a dressing when you leave, we will arrange for your GP’s practice nurse or a district nurse to change it regularly, and check the wound. It is OK to have a shower.

You should be able to gradually resume normal activities as soon as you feel well enough. Avoid heavy lifting and frequent stretching at first.

What you can do to help yourself

Smoking

If you are a smoker, the most important thing you can do to help yourself is to give up smoking. Stopping smoking will also help to protect all of your arteries, making it less likely that you will suffer from heart attacks or strokes. If you would like to give up smoking, please speak to your nurse or contact our Stop Smoking service, phone 020 7188 0995, or the NHS Smoking Helpline, phone 0300 123 1044.

Activity

Gentle exercise, such as walking or cycling, is recommended to help improve your overall fitness. Exercise helps your body to produce healthy cholesterol and this helps to protect your arteries against bad cholesterol.

Blood pressure

It is important to have your blood pressure checked regularly, at least every 6 months. If you have been prescribed medicine for high blood pressure, you must make sure that you take it following the instructions given.

Diabetes

If you have diabetes, it is important that your blood sugar levels are well controlled.

Cholesterol (fatty substance in your blood)

You should eat a healthy, balanced diet and try to reduce any excess weight. It is important to reduce the level of cholesterol in your blood. Your vascular nurse can refer you to a dietitian if needed.

You might be prescribed medicine (such as statins), and a low dose of aspirin, to help lower your cholesterol level and prevent blood clots from forming.