Applying the Suprainguinal Approach of Fascia Iliaca Compartment Block for Surgical Anesthesia in a Patient Undergoing Emergency Femoral Thrombectomy: A Case Report

We present the first documented case of achieving surgical anesthesia for a vascular surgery using the suprainguinal approach of the fascia iliaca compartment block (SFICB), in a patient with severe comorbidities from the cardiovascular system. More specifically, a male elderly patient with a history of cardiac amyloidosis, severe aortic stenosis, and coronary artery disease, was in need of emergent thrombectomy due to acute lower limb ischemia. During the evaluation of this patient, general and neuraxial anesthesia were both considered. However, the former would expose him to the risk of myocardial ischemia and other complications due to cardiovascular instability caused by the general anesthetic agents while the latter was absolutely contraindicated due to recent clopidogrel use and the specific pathophysiology changes induced by cardiac amyloidosis. Thus, a peripheral nerve block was deemed to be the best option in this case. SFICB, despite being challenging, could offer adequate analgesic results so it was the anesthetic technique of choice. The surgery was completed and the patient recovered appropriately. The aim of this report is to discuss the specific anesthetic considerations of this case, highlight the ability of SFICB to achieve surgical anesthesia in vascular surgeries, and increase familiarity with the procedure.