Endarterectomy Overview

Atherosclerosis is hardening of a blood vessel from a build up of plaque. Plaque is made of fatty deposits, cholesterol, and calcium. It builds on the inside lining of arteries. This causes the artery to narrow and harden. As plaque builds up, it can slow and even stop blood flow.

Endarterectomy is a surgery to remove this build-up and improve blood flow. Surgery is most often performed on:

• Carotid arteries in the neck that supply the brain—most common use of endarterectomy
• Aorta—a major artery that runs from the heart to the abdomen
• Iliac and femoral arteries—supply the legs
• Renal (kidney) arteries

Bilateral Carotid Artery Atherosclerosis © 2009 Nucleus Medical Media, Inc.

If you are planning to have endarterectomy, your doctor will review a list of possible complications, which may include:

• Bleeding
• Stroke (particularly if the carotid arteries are involved)
• Blood clots
• Adverse reaction to the anesthesia
• Infection

Some factors that may increase the risk of complications include:

• Poor overall health
• Advanced age
• Plaque build-up in other vessels
• Other serious diseases (eg, heart failure , uncontrolled high blood pressure , diabetes , cancer , kidney disease )

Be sure to discuss these risks with your doctor before the procedure.

Prior to Procedure

Before the surgery, your doctor will:

• Give you an exam to make sure that you are healthy enough for the surgery
• Order studies that show detailed images of your arteries

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Anti-inflammatory drugs (eg, aspirin )
• Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

In addition, you may be instructed to:

• Avoid eating or drinking after midnight the night before the surgery.
• Arrange for a ride home from the hospital.

Anesthesia

You may have:

• General anesthesia —blocks any pain and keeps you asleep through the surgery; given through an IV in your hand or arm
• Local anesthesia—numbs an area of your body so that you stay awake through the surgery; may be given as an injection

Description of the Procedure

Incisions will be made over the diseased part of the artery. The location will depend on the artery that is being unblocked.

In the abdomen and legs, the doctor will clamp the artery above the obstruction during the repair. The lower half of the body can go without a blood supply for long enough to do the surgery. If surgery is done on the neck, the doctor may first reroute (bypass) the blood around the surgical site. This will keep blood going to the brain.

The doctor will then clean out the inside of the artery, being careful not to have small fragments of the deposits break off and flow downstream. Once the artery is cleaned out, the skin will be closed with sutures or staples.

How Long Will It Take?

Several hours (depending on the severity of the disease)

How Much Will It Hurt?

After surgery, there will be pain from the incisions. Ask your doctor about medicine to help with the pain.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is one day to one week. Your doctor may choose to keep you longer, however, if complications arise.

Post-procedure Care

At the Hospital

While you are recovering at the hospital, you may receive the following care:

• You will be monitored to make sure that you are not bleeding, clotting, or developing an infection.
• You will also be monitored to make sure that your wound is healing properly and that your pain is managed.

At Home

When you return home, do the following to help ensure a smooth recovery:

• Have your sutures (or staples) removed when instructed.
• If advised by your doctor, take blood thinners.
• If you had abdominal surgery, gradually resume your normal eating habits.
• To help reduce the risk of plaque build-up, make changes to your diet, such as eating a diet:

• Low in saturated fat
• High in fruits and vegetables
• High in grains and fish
• If advised by your doctor, work with a nutritionist.
• Be sure to follow your doctor’s instructions .

RESOURCES:

American Heart Association
http://www.americanheart.org/

Peripheral Vascular Surgical Society
http://www.pvss.org/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index-eng.php

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/splash/

References:

Atherosclerosis endarterectomy. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/endarterectomy/vsatherosclerosisendarterectomy.aspx . Accessed on January 11, 2009.

Endarterectomy. Society for Vascular Surgery website. Available at: http://www.vascularweb.org/CONTRIBUTIONPAGES/Patient_Information/NorthPoint/Endarterectomy.html . Accessed August 19, 2005.

Greenfield, Lazar J, Mulholland MW, et al. Aortoiliac Disease in Surgery: Scientific Principles and Practice. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2001.

University of Michigan Health System website. Available at: http://www.med.umich.edu/1libr/tests/testa13.htm . Accessed August 19, 2005.