Endarterectomy

BASIC FACTS

  • Endarterectomy is the surgical removal of plaque from the walls of an artery.
  • Endarterectomy can be performed on various arteries in the body but is most commonly done on the internal carotid artery in the neck.
  • Patients who receive a carotid endarterectomy have moderate to severe atherosclerosis.
  • Endarterectomy is the surgical removal of deposits in arteries that are moderately to severely narrowed from atherosclerosis (hardening of the arteries).
  • Endarterectomy can be performed on various arteries but is most commonly done on the internal carotid artery in the neck.

WHEN IS IT INDICATED?

Endarterectomy may be indicated in patients who have one of the following:

  • Carotid artery disease
  • Coronary heart disease
  • Peripheral arterial disease (PAD)
  • Renal (kidney) artery disease
  • Aortic arch conditions
  • Aortoiliac (leg artery) occlusive disease
  • Visceral artery conditions (impaired blood flow to intestines/stomach)

Endarterectomy may be performed to clear plaque from arteries in the leg. Endarterectomy is generally indicated if the patient’s artery is narrowed by more than 50 percent or if the patient has had one or more symptoms of artery disease, including:

  • Temporary loss of vision, speech, or sensory or motor functions on one side of the body or in one leg or arm (carotid artery disease)
  • Critical ischemia, or severe pain in the leg because of a lack of oxygenated blood, (leg artery disease)
  • Gangrene, or tissue death caused by a restricted blood supply to a limb

PRE-TREATMENT GUIDELINES

Because candidates for endarterectomy are at higher risk for stroke and heart attack, the physician may recommend:

  • A cardiovascular health assessment
  • A patient take platelet-blocking medications up to 4 days in advance

A physician may order the following tests:

  • Duplex ultrasound
  • Arteriography
  • Computed tomography (CT) angiography
  • Magnetic resonance angiography (MRA)

WHO IS ELIGIBLE?

Some conditions that may exclude patients from the procedure or increase the risk for complications include:

  • Cancer
  • Uncontrolled high blood pressure
  • Diabetes mellitus
  • Unstable angina (chest pain)
  • Heart attack in the previous 6 months
  • Congestive heart failure
  • Signs of progressive neurologic dysfunction (such as Alzheimer’s)
  • A prior stroke
  • Advanced age
  • Surgically inaccessible plaques
  • Plaque blockage in other blood vessels
  • A previous endarterectomy
  • Problems with other blood vessels in the head

WHAT TO EXPECT

An endarterectomy can be performed with the patient under local, regional, or general anesthesia. During general anesthesia, machines for monitoring blood pressure, temperature, and brain function are used.

The surgeon makes an incision in the skin in the neck above the site of blockage in the carotid artery. The surgeon inserts a tube above and below it to temporarily reroute blood flow (called a shunt) or manually stops blood flow briefly. The procedure is similar for peripheral arteries.

The surgeon uses a scraping tool to remove fatty deposits or the blood clot and the innermost layer of the artery where it forms. Once cleaned, the blood vessel may be covered with a synthetic graft or part of the patient’s vein. Any shunts are removed and the incisions sutured (sewn). The surgery typically lasts about 2 hours. A small tube (catheter) may be left near the incision to drain excess fluid.

POSSIBLE COMPLICATIONS

Complications of endarterectomy can include:

  • Excessive bleeding
  • Infections
  • Stroke

POST-PROCEDURE GUIDELINES AND CARE

Most patients stay overnight in a regular hospital room for observation. Those who have had carotid surgery must elevate their head and have it immobilized for at least 24 hours afterward. During recovery, patients:

  • Receive intravenous fluids
  • Are monitored with an electrocardiogram (ECG)
  • Are checked for signs of bleeding, stroke, or compromised blood flow to the brain

Most patients are discharged 1 to 2 days after surgery. Patients return in 1 month for a follow-up examination. Patients should immediately alert their physician to any signs of the following:

  • Weakness
  • Numbness
  • Speech impairment
  • Vision impairment
  • Chest pain
  • Excessive sweating
  • Nausea
  • Difficulty breathing

LIFESTYLE ADJUSTMENT

To reduce the risk of atherosclerosis, patients should eliminate unhealthy lifestyle factors, such as:

  • Smoking
  • Excess weight
  • Lack of exercise
  • A diet high in saturated fat and trans fats

[NOTE: This is an abbreviated version of the complete article. If you would like to read this article in its entirety, please call our office at (307) 778‐1849 and ask to meet with one of our specialists to receive a ‘Prescription Pad’ registration form. If you already have a ‘Prescription Pad’ form, please login and follow the instructions listed on the form. If you experience any issues during the registration process, please call member services at 1 (800) 603-1420 for assistance.]

Medical Review Date: July 28, 2008 / Copyright © 2012 NorthPoint Domain, Inc. All rights reserved. This material cannot be reproduced in digital or printed form without the express consent of NorthPoint Domain, Inc. Unauthorized copying or distribution of NorthPoint Domain’s Content is an infringement of the copyright holder’s rights.

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