Femoral Pseudoaneurysm Repair

Anesthesia Implications

Position: Supine
Time: 1-2 hours (average)
Blood Loss: Very High (500+ ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: Yes
Lead: Yes

You’ll need an A-line and two large bore IV’s.

Anticipate having a Neo drip ready and “downers” as well (Cardizem, Nitroglycerine, etc.).

Heparin will be used, so anticipate ACT’s being drawn at regular intervals.

Labile hemodynamics are common and will require vigilant monitoring.

ICU transport post-op.

High Blood Loss (general considerations): Type and cross, CBC, and CMP should be done prior to the procedure. Consider having an A-line, blood tubing, and extra push-lines. Depending on the fragility of the patient, you may want to have blood in the room and available.

Fluoroscopy / Xray (general considerations): Have lead aprons and thyroid shields available. Alternatively, distancing yourself 3 to 6 feet will reduce scatter radiation to 0.1% to 0.025% respectively. Occupational maximum exposure to radiation should be limited to a maximum average of 20 Sv (joules per kilogram – otherwise known as the Sievert/Sv) per year over a 5 year period. Limits should never exceed 50 Sv in a single year.

Arterial line (general considerations): Preoperatively check pulses to gauge the best side to attempt the A-line. Perform an Allen test to ensure adequate blood flow. Have the A-line equipment set up and ready in the room.

A pseudoaneurysm is a pulsatile, contained hematoma of an artery. All layers of the vessel have been damaged. Surrounding tissues may also become ischemic and/or necrotic including neighboring blood vessels, nerves, muscle, etc. For this reason and the possibilities of rupture with subsequent massive blood loss, these kinds of cases are generally considered emergencies.