Endarterectomy
Endarterectomy is a surgical procedure aimed at removing plaque buildup from the carotid arteries located in the neck, primarily to treat conditions related to peripheral and carotid artery disease. This intervention is crucial for restoring blood flow to the brain, thereby preventing ischemia, loss of consciousness, or strokes. The procedure begins with a careful incision and inspection of the carotid artery and surrounding structures. Specialized clamps are used to control blood flow and minimize the risk of emboli during the operation. The plaque is typically removed through a lengthwise incision in the artery, and any necessary repairs are made, sometimes utilizing a segment of the patient's saphenous vein to patch the artery if damage is extensive.
While endarterectomy can significantly decrease the risk of strokes, particularly in younger patients, it is not without potential complications, such as the formation of emboli that may lead to further vascular blockages. Following the procedure, patients generally return for a follow-up appointment to ensure proper healing and function. Overall, endarterectomy is regarded as a successful method for restoring normal circulation and enhancing patient outcomes.
Endarterectomy
Anatomy or system affected: Blood vessels, circulatory system, neck
Definition: A surgical procedure used to remove plaque from the lining of the carotid arteries in the neck
Indications and Procedures
Endarterectomy is a surgical procedure used to remove plaque from the lining of the carotid arteries in the neck. It is used to treat patients suffering from peripheral and carotid artery disease. The internal carotid artery lies on the side of the neck, slightly in front of and beneath the sternocleidomastoid muscle. A skin incision is made anterior to this muscle. The branches of the carotid artery, adjacent blood vessels, and nerves are freed and inspected. A clamp is applied to the common carotid artery. Two additional clamps are applied to the external and internal carotid arteries prevent bleeding and to prevent emboli from migrating to the brain during the procedure.
A lengthwise incision is made in the internal carotid artery from a point about 3.8 centimeters (1.5 inches) above the beginning of the vessel into the common carotid artery, about 2.5 centimeters (1 inch) below the beginning of the vessel. The edges of the artery are retracted, and the interior is exposed. The plaque can usually be scraped off the walls of the artery. The internal lining of the artery is carefully closed, and any tears are sutured. The carotid artery is then sewn together with fine suture material. If the underlying disease has been extensive or if the lining of the artery is damaged, a portion of the saphenous vein in the patient’s leg is used to repair the arterial wall.
Restoring blood flow is crucial; it is important to avoid both leaks in the artery and the formation of emboli. The clamp on the external carotid artery is briefly released, and a small amount of blood is allowed to flow back into the repaired area to check for leaks under low pressure. This clamp is reapplied. The clamp on the common carotid artery is removed to check for leaks under high pressure. The clamp to the external carotid artery is removed next. Blood is allowed to flow, flushing any emboli from the operative site and away from the brain. If all is well, the clamp on the internal carotid artery is removed.
The structures that were pulled away from the carotid artery are released and briefly inspected to ensure that no damage has been done. The edges of the skin are then brought together and closed with sutures. The patient returns in about a week for a checkup and removal of the sutures.
Uses and Complications
Endarterectomy is used to restore adequate blood flow to the brain, thus preventing periods of ischemia that can result in loss of consciousness or strokes. However, complications can include emboli, which can also cause strokes by blocking important blood vessels. Endarterectomy is successful in most patients and restores more normal circulation. It has decreased the incidence of strokes in younger patients.
Bibliography
Ancowitz, Arthur. Strokes and Their Prevention: How to Avoid High Blood Pressure and Hardening of the Arteries. New York: Jove, 1980.
Browse, Norman L., A. O. Mansfield, and C. C. R. Bishop. Carotid Endarterectomy: A Practical Guide. Boston: Butterworth-Heinemann, 1997.
“Endarterectomy: Treatment for Peripheral Artery Disease.” Cleveland Clinic, 29 Aug. 2022, my.clevelandclinic.org/health/treatments/17312-pad-endarterectomy. Accessed 22 July 2023.
Loftus, Christopher M. Carotid Endarterectomy: Principles and Technique. 2d ed. New York: Informa Healthcare, 2007.
Loftus, Christopher M., and Timothy F. Kresowik. Carotid Artery Surgery. New York: Thieme, 2000.
NIH National Heart, Lung, and Blood Institute. "What Is Carotid Endarterectomy?" NIH National Heart, Lung, and Blood Institute, December 1, 2010.
Polsdorfer, Ricker. "Endarterectomy." Health Library, May 6, 2013.
Rutherford, Robert B. et al., eds. Rutherford's Vascular Surgery. 7th ed. Philadelphia: Saunders/Elsevier, 2010.
Topiwala, Shehzad. "Carotid Artery Surgery." MedlinePlus, June 4, 2012.