This is an abbreviated version of the complete article.*
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; or
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); or
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; and
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; and
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; and
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.
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); and
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; or
Difficulty breathing.
POSSIBLE COMPLICATIONS
Complications of endarterectomy can include:
Excessive bleeding;
Infections; and
Stroke.
LIFESTYLE ADJUSTMENT
To reduce the risk of atherosclerosis, patients should eliminate unhealthy lifestyle factors, such as:
Smoking;
Excess weight;
Lack of exercise; and
A diet high in saturated fat and trans fats.
Medical Review Date: July 28, 2008
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