Definition

An endarterectomy is a type of vascular surgery done to remove atherosclerotic debris, or “plaque,” from the lining of an artery to re-establish blood flow.

Over decades of time, the disease known as atherosclerosis builds up deposits inside arteries. These deposits consist of fat (cholesterol) and scar tissue. Later on, they gather calcium and become like egg shells. In the process, they narrow the arteries so that blood flow is restricted.

This surgery, when performed on other than the carotid (neck) artery, is often complemented or substituted by bypass grafting, wherein a piece of artificial tubing or a vein from your leg is attached to an artery above and below the obstruction so that blood can flow around it.

There are less invasive procedures called atherectomy, percutaneous angioplasty, and endovascular stent graft repair that may be used for more limited disease.

Bilateral Carotid Artery Atherosclerosis

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Parts of the Body Involved

All major arteries can be involved in the atherosclerotic disease process. Surgery is most often directed to the following:

  • Carotid arteries in the neck that supply the brain—This is the most common use of endarterectomy (about 95% of the cases).
  • Aorta (more commonly in the abdomen than in the chest)
  • Iliac and femoral arteries that supply the legs
  • Renal (kidney) arteries

Reasons for Procedure

The main reason for performing this procedure is to clear atherosclerotic disease that obstructs blood flow.

Risk Factors for Complications During the Procedure

The risk of endarterectomy depends upon the artery being operated upon. A carotid endarterectomy carries low risk of complications, the major ones stroke and heart attack . If the iliac arteries are being repaired, usually long and multiple incisions are required. Long hours are spent in the operating room, and meticulous technique is essential.

Risks specific to vascular surgery are bleeding and clotting. During the surgery, the blood is thinned so that it will not clot. After the surgery, clotting function must be restored. Bleeding from the surgical site can occur, requiring reoperation. Additionally, a small clot or piece of damaged artery can embolize— travel through the artery until it lodges in a smaller vessel—shutting off blood supply and threatening death of the involved body part. If this happens, blood flow must be restored immediately by another surgical procedure.

What to Expect

Prior to Procedure

You will have an extensive evaluation to assure that you are healthy enough to undergo surgery. Detailed images of your arteries will be performed by angiogram using either conventional x-rays or computerized scanning (CT or MRI). You may be in the hospital for one day or many days, depending upon the artery involved.

Anesthesia

You will undergo a general or regional anesthesia.

Description of the Procedure

Incisions will be made over the diseased segments of the affected arteries. These may extend the length of your abdomen and one or both thighs or just your neck, depending upon where the obstructions are.

Your blood will be thinned so that it does not clot during the procedure. In the abdomen and legs, the surgeon will clamp the artery above the obstruction while doing 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 surgeon may first reroute (bypass) the blood around the surgical site to keep blood going to the brain.

Because the diseased artery has small fragments that may embolize (break off and flow downstream), all the abnormal tissue must be carefully removed and the artery repaired so that blood will flow smoothly and not clot in irregularities. This is the atherectomy part of the procedure. Sometimes, instead of repairing the artery, a bypass is performed using an artificial tube or a vein from the leg. At other times, part of the artery is removed, and the remaining piece is patched with artificial material or vein.

At the end of the surgery the blood-clotting mechanisms will be restored.

After Procedure

Recovery from surgery may take several days. The medical team will want to make sure that bleeding, clotting, infection, and drug reactions are not happening; that the wound is healing properly; and that your pain is adequately controlled.

How Long Will It Take?

Vascular surgery can last for many hours, depending upon the extent of the disease in the arteries. You will be asleep throughout the procedure, no matter how long it takes.

Will It Hurt?

After surgery, there will be pain in the incisions, depending upon which artery was repaired.

Possible Complications

Bleeding and clotting at the sites of surgery are the most common complications specific to vascular surgery. If either occurs, you may require more surgery. Infection and drug reactions are risks inherent to all surgery. If the abdomen was opened, there may be constipation.

Average Hospital Stay

One day to one week

Postoperative Care

Incisions will need to heal. Sutures (or staples) will be removed during the second week after surgery. Meals may have to be resumed gradually if the abdomen was entered. You may be on a blood thinner for a while.

Outcome

It is expected that the initial symptoms due to the reduced blood flow will disappear. Initial symptoms may have been strokes, dizzy spells, digestive problems, leg cramping, or ankle ulcers. The atherosclerotic disease process, however, will continue, so you will be counseled regarding cholesterol, diet, exercise, smoking, and lifestyle changes. You will probably be given medications to take regularly.

Call Your Doctor If Any of the Following Occurs

  • Color changes (blue or white), numbness, or burning in your legs
  • Increasing pain after surgery
  • Dizzy spells or strokes
  • Fever, rash, vomiting, diarrhea, trouble breathing, failure to urinate, constipation, bleeding, or discharge from incisions