Acute Limb Ischemia Thrombectomy/Embolectomy Operative Note

Date/Time of Procedure: [Procedure date and time]

Location: [OR / hybrid suite / cath lab]

Urgency: [emergent / urgent] [Limb-threatening status if applicable]

Primary Surgeon: [Name, credentials]

Assistant(s): [Name(s), credentials / None]

Anesthesia Type: [general / regional / MAC / local with sedation] [Airway type if applicable]

Laterality and Target: [Right / Left / Bilateral] — [Target vessel segments and procedure focus]

Preoperative Diagnosis

• ALI laterality and anatomic levels: [Right / Left / Bilateral] — [aortoiliac / femoropopliteal / tibial / pedal / graft thrombosis / stent thrombosis / multiple levels]
• Associated diagnoses/risk factors: [atrial fibrillation / recent MI / LV thrombus / prosthetic valve / aneurysm disease / prior bypass / prior stent / hypercoagulable state / trauma / iatrogenic / other / none] (Include only if applicable)
• Rutherford category: [I / IIa / IIb / III] (If not formally assessed, document objective motor status, sensory status, and arterial/venous Doppler signals with reason classification was not completed)

Postoperative Diagnosis

[Same as preoperative diagnosis unless modified by intraoperative findings]

• Clarified etiology: [embolus retrieved / in situ thrombosis with underlying stenosis / graft failure / stent failure / uncertain] (Use qualified language if not definitive; provide supporting evidence)

Procedures Performed

• [Exposure approach] — [Laterality and specific vessel segments]
• [Open thromboembolectomy / thrombectomy] — [Vessel segments: proximal/distal, named arteries]
• [Adjunct open procedures if performed: endarterectomy / patch angioplasty (material) / bypass (conduit and configuration)]
• [Adjunct endovascular maneuvers if performed: angiography / balloon angioplasty (size, segment) / stent placement (type/size/location) / aspiration thrombectomy / catheter-directed thrombolysis]
• [Completion assessment modality: completion angiography / intraoperative duplex / Doppler signals (arteries specified)]
• [Fasciotomy if performed: therapeutic vs prophylactic; compartments released and side(s)]
• [Wound management: primary closure / patch / open with packing / NPWT]

Clinical Summary and Ischemia Timeline

[Brief clinical presentation and rationale for urgent/emergent intervention] (Summarize symptom pattern, neurologic/vascular deficits, and decision rationale)

Symptom Onset (or Last Known Well): [Timestamp / Unknown — provide best anchor]

Time of Presentation/Diagnosis: [Timestamp / Unknown]

Time Systemic Anticoagulation Started: [Timestamp with agent and dose / Unknown / Not applicable]

Incision Time: [Timestamp]

Time of Reperfusion: [Timestamp / Unknown] (Restoration of inline flow or first documented distal Doppler signal)

Consent: [Informed consent obtained from patient/surrogate acknowledging material risks (limb loss, bleeding, reperfusion injury, fasciotomy, reintervention) / Emergent necessity — standard consent not feasible; rationale documented]

Intraoperative Findings

• Occlusion location and extent: [Anatomic segments involved; length/severity]
• Nature of material retrieved: [thrombus / embolus]; [fresh / organized]; [volume/character]
• Underlying lesions: [stenosis (degree/location) / dissection / intimal flap / graft or stent failure / aneurysm / none identified]
• Inflow/outflow status: [Inflow adequacy]; [Runoff vessels patent/occluded]; [Quality of distal targets]
• Distal embolization events: [None / Occurred — management described]
• Compartment status/muscle viability: [tense / soft]; [muscle color, contractility, bleeding] (Include if evaluated)
• Etiology assessment: [Appearance consistent with embolus / in situ thrombosis / uncertain — supporting evidence] (Use qualified language if not definitive)

Operative Description

Setup: [Patient positioning]; [Limb prep and drape]; [Antibiotic prophylaxis agent and timing]

Anticoagulation: [Heparin bolus dose and timing]; [Monitoring method (ACT/aPTT) and values]; [Additional boluses if given]; [Protamine reversal: given/not given with rationale]

Exposure: [Incision location(s)]; [Proximal and distal vessel control]; [Arteriotomy location and size]

Thrombectomy/Embolectomy Technique: [Catheter types/sizes]; [Proximal and distal passes with number]; [Endpoints: backbleeding, antegrade flow, palpable thrill, improved Doppler]; [Flush technique and agents]; [Management of residual thrombus if present]

Adjunct Procedures: [Access site(s)]; [Wires/catheters]; [Target lesion(s)]; [Balloon/stent sizes and locations]; [Contrast volume]; [Intravascular imaging if used] (Include only if performed)

Completion Assessment: [Completion angiography / Intraoperative duplex / Doppler signals (specify arteries)] — [Findings: restoration of inline flow, runoff status, residual stenosis/defect] (If incomplete revascularization, state reason and plan for staged reintervention)

Fasciotomy: [Indication: compartment syndrome (therapeutic) / high-risk reperfusion (prophylactic)]; [Compartments released: 2-compartment vs 4-compartment; leg/thigh/foot]; [Incision locations]; [Findings: muscle bulge, contractility, color, bleeding]; [Wound management: open packing / NPWT; planned relook timing; closure expectations] (Include only if performed)

Closure and Final Assessment: [Arteriotomy closure: primary / patch (material)]; [Hemostasis achieved]; [Drain/NPWT placement]; [Final limb assessment: pulses/Doppler signals by artery, capillary refill, temperature/color, motor and sensory status]; [Patient condition at transfer]

Case Summary

Estimated Blood Loss: [mL]

Fluids/Transfusion: [IV fluids, blood products, cell saver / Refer to anesthesia record]

Specimens: [Thrombus/embolus to pathology / Cultures / None / Not documented]

Implants: [Patch material, grafts, stents with identifiers / None / Not documented]

Drains/Wound Devices: [JP drain(s) / NPWT / None / Not documented]

Complications: [None / Describe event and management / Not documented]

Patient Condition at End of Case: [Hemodynamics; airway status; overall stability]

Disposition: [PACU / ICU / Ward]; [Intubated / Extubated]

Postoperative Plan

Anticoagulation Plan: [Immediate agent (e.g., UFH infusion) with target aPTT/anti-Xa]; [Transition strategy and timing criteria]; [Antiplatelet plan if stent/angioplasty performed]; [Contraindications/bleeding concerns and mitigation]

Limb Monitoring: [Neurovascular check frequency]; [Compartment monitoring criteria for fasciotomy or re-exploration]; [Limb positioning and activity restrictions]

Reperfusion Monitoring: [Lab surveillance: CK, potassium, lactate, creatinine with frequency]; [Fluid strategy and urine output goals]; [Electrolyte management]

Wound/Fasciotomy Plan: [Dressing/NPWT plan]; [Timing of relook]; [Closure vs grafting expectations] (Include if applicable)

Etiology Workup: [Telemetry duration]; [Echocardiography]; [Vascular imaging for aneurysm or inflow lesions]; [Hypercoagulable evaluation] (Include if indicated)

Immediate Vascular Status: [Distal pulses or Doppler signals by named artery]; [Capillary refill]; [Foot warmth and color]

(For fields without available information, populate with "None" or "Not documented" rather than omitting — especially for specimens, implants, drains, complications, anticoagulation plan, and completion assessment. Use absolute timestamps where available; if unknown, state "Unknown" with best available anchor. When etiology is uncertain, use qualified language and provide supporting intraoperative evidence. Ensure laterality is explicitly stated in the header, diagnoses, and procedures performed.)