Endarterectomy

An endarterectomy is a surgical procedure for removing blockages in arteries that have developed as a result of arteriosclerosis (vascular calcification). This operation is frequently used to treat blockages or narrowing of the carotid artery in the neck or the arteries in the legs.

Arteriosclerosis is commonly known as vascular calcification and involves the build-up of deposits (plaque) on the inside wall of the artery. Over time these deposits make the blood vessel narrower. An endarterectomy is the surgical removal of this plaque and the resulting vascular blockages. All the arteries in the body can be affected by arteriosclerosis. The treatment options available for blockages of the coronary arteries are explained in the coronary artery surgery section. Sometimes a stent is used instead of an endarterectomy procedure. This technique is discussed in the stent section.

After heart diseases and disorders, the most common conditions treated using an endarterectomy are arteriosclerotic changes in the main neck artery (carotid artery) and the narrowing of arteries in the legs (peripheral arterial occlusive disease). The procedure is essentially the same in both cases. The next section will therefore only describe the surgery used to treat the carotid artery.

Carotid endarterectomy

In its early stages, the narrowing of the carotid artery (carotid stenosis) leads to temporary circulatory disorders in the brain. These are called transient ischemic attacks and they are a warning sign of an impending stroke. Endarterectomies are used to remove plaque from the carotid artery, thereby correcting the circulatory disorder and helping to prevent a stroke.

What preparations are carried out before the procedure?

Before the operation the patient must undergo various examinations to determine the location and extent of the stenosis. These include CT and MRI scans, an angiogram and an ultrasound examination.

All the usual pre-operative assessments are also required, such as a blood test, blood pressure measurement and an ECG. All blood-thinning medication must be discontinued prior to surgery. The patient is usually admitted to hospital on the day before the procedure. They should have an empty stomach when they go into surgery.

How is the operation performed?

The operation is performed under general anaesthetic. The blocked carotid artery is accessed via an incision in the neck. The affected part of the artery is clamped (to stop the blood flow), opened and the plaque is removed. A temporary bypass may be necessary if the brain is at risk of not receiving enough blood while the artery is clamped. The affected part of the artery may be extended using a vein or artificial patch. Afterwards the blood vessel is closed with a micro stitch.  The operation takes around one hour.

What is the success rate of this procedure?

This operation fixes the stenosis. However, it does not affect the underlying condition that led to the arteriosclerosis.

What are the possible complications and risks of this procedure?

This is a low-risk operation and generally does not result in complications. As with all surgery, the operation sometimes leads to complications such as infections, post-operative haemorrhaging and blood clots. In rare cases microembolisms can develop during the operation, which could cause a stroke.

What happens after the operation?

Patients who have received surgical treatment for blocked arteries should have regular check-ups and may be required to take blood-thinning medication. Existing medical conditions such as high blood pressure or diabetes must continue to be treated. Ideally the patient should change their lifestyle to slow the progress of the arteriosclerosis: healthy diet, lots of exercise, stress reduction, quitting smoking.