Name of the Procedure:

Embolectomy or thrombectomy, with or without catheter; carotid, subclavian or innominate artery, by neck incision.

Summary

In layman's terms, this procedure involves the surgical removal of a blood clot (embolus or thrombus) from major arteries in the neck. The goal is to restore normal blood flow to prevent serious complications like stroke.

Purpose

This procedure addresses blood clots that block arteries, specifically the carotid, subclavian, or innominate arteries. The primary goal is to re-establish proper blood circulation, alleviating symptoms such as pain, numbness, or even preventing potential life-threatening events like strokes.

Indications

• Symptoms such as severe headache, dizziness, transient ischemic attacks (TIAs), or arm weakness due to reduced blood flow.
• Confirmed diagnosis of arterial blockage in the neck through imaging tests.
• Patients with risk factors like atherosclerosis, previous strokes, or significant cardiovascular disease.

Preparation

• Fasting for a specified period before the procedure (usually 8-12 hours).
• Adjustment or temporary discontinuation of certain medications, especially blood thinners.
• Pre-procedural imaging tests like Doppler ultrasound, CT angiography, or MRI to locate and assess the extent of the blockage.

Procedure Description

1. The patient is positioned and given general or local anesthesia for comfort.
2. A surgical incision is made in the neck to access the affected artery.
3. The surgeon may use a catheter to help remove the clot or directly remove it through the incision.
4. The artery is then repaired, sometimes using a patch to widen the artery and prevent future clots.
5. The incision is closed with sutures, and the area is bandaged.

Duration

The procedure typically takes about 1-3 hours, depending on the complexity and extent of the blockage.

Setting

This procedure is performed in a hospital's surgical unit or specialized vascular surgery center.

Personnel

• Vascular surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection at the incision site.
• Bleeding or hematoma formation.
• Nerve damage affecting neck or shoulder movement.
• Recurrent blockage or clot formation.
• Rarely, stroke or transient ischemic attacks (TIAs) during or after the procedure.

Benefits

• Restoration of normal blood flow.
• Immediate relief of symptoms like dizziness or arm weakness.
• Reduced risk of stroke or other serious complications related to blocked arteries.

Recovery

• Post-procedure monitoring in the hospital for 1-2 days.
• Instructions to avoid heavy lifting or strenuous activity for a few weeks.
• Follow-up appointments to monitor healing and artery health.
• Pain management with prescribed medications.

Alternatives

• Medications such as anticoagulants to manage blood clots.
• Angioplasty with stenting might be considered less invasive.
• Lifestyle modifications and regular monitoring for less severe blockages.

Pros and Cons of Alternatives

• Medications may take longer to act and are less effective for large clots.
• Angioplasty is less invasive but may not be suitable for all types of clots.
• Lifestyle changes alone may not address significant blockages as effectively as surgery.

Patient Experience

• Patients are typically asleep or numb during the procedure due to anesthesia.
• Post-procedure, patients may experience mild to moderate pain managed with medication.
• Some discomfort at the incision site, but it subsides as healing progresses.
• Most patients notice significant improvement in symptoms almost immediately after regaining strength.