Femoral TEA and deep femoral artery patch plasty

1. Arteriotomy of common femoral artery (CFA): use scalpel with blade Nr 11, perform stab incision holding blade upward, extend arteriotomy with Potts scissors
2. Direction of incision: CFA front wall to the split of the bifurcation, then along inner side of branches (see drawing): alike ‘zipper and sutures’ of a blue jeans
3. Perform thrombendarterectomy of deep femoral artery (DFA) and superficial femoral artery (SFA) (it's incision should be 1 cm longer than in the DFA)
4. Fix distal intimal flap in the DFA using tack down stitches if necessary to avoid dissection
5. Cut the SFA 1 cm distal to DFA incision and ligate the distal SFA end
6. Place a stay suture at the tip of the SFA flap which now becomes the patch for the DFA reconstruction
7. Use a running suture, starting at back side of reconstruction. DFA to be sutured from inside out, SFA to be sutured from outside in. Use stay suture at the tip of SFA flap as guidance of the flap

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Alternative: use an autologous or another patch if superficial femoral artery is to be maintained

1. Before reaching end of incision in DFA trim the SFA flap to fit the reconstruction (don’t cut the tip as a triangle! Leave it round)
2. Continue with running suture to middle of CFA
3. Second suture starting from proximalCFA incision to the middle
4. Flush and complete anastomosis
5. Completion angiography

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Control of learning targets

• Understanding of incision line („suture line of blue jeans“)
• Distal tack down sutures
• Everting anastomotic technique
• Regularity of stitches
• Tightness of suture
• Configuration of reconstructed bifurcation