Indications
Injury to femoral artery or profunda femoris
On table angiogram
Longitudinal incision
- midpoint ASIS and pubic symphysis
- open femoral sheath
- NAVY
- insert catheter into artery
- inject contrast and follow with II
Exposure
Checroun et al J Orthop Trauma 1996
- extensile medial approach to femur
https://pubmed.ncbi.nlm.nih.gov/8892148/
Position
Patient supine
- hip abducted / extended / externally rotated with knee bent
- Figure of 4 position
Incision
Centre of the mid inguinal point
Extends over knee to 1 cm posterior border tibia
Dissection
Proximal dissection
- divide deep fascia over sartorius
- retract sartorius anteriorly to expose femoral artery
- base of femoral artery is adductor longus
Distal dissection
- interval between sartorius posteriorly and vastus medialis anteriorly
- expose adductor canal on adductor magnus
Knee
- detach medial head of gastrocnemius to expose popliteal artery
- at tibia detach soleus to expose trifurcation
Anastomosis
- first clear artery with embolectomy
- vein patch graft or anastomosis with reversed great saphenous vein
- repair 6.0 prolene non cutting needle