Name of the Procedure:

Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision

Common Name(s): Carotid Endarterectomy, Vertebral Endarterectomy, Subclavian Endarterectomy

Summary

Thromboendarterectomy is a surgical procedure to remove atherosclerotic plaque from the inner walls of specific arteries in the neck, potentially including the use of a patch graft to widen the artery. It aims to improve blood flow and prevent stroke or other complications related to restricted blood flow.

Purpose

The procedure is performed to address significant narrowing (stenosis) or blockage of the carotid, vertebral, or subclavian arteries due to atherosclerosis. It aims to restore adequate blood flow to the brain and upper extremities, thereby reducing the risk of stroke and other ischemic events.

Indications

• Symptoms such as transient ischemic attacks (TIAs) or minor strokes linked to arterial narrowing.
• Patients with significant arterial stenosis detected through diagnostic imaging.
• Asymptomatic patients with severe arterial stenosis and high stroke risk factors.

Preparation

• Patients may be required to fast for a certain period before surgery.
• Blood tests and imaging studies, such as ultrasound or MRI, to assess the degree of stenosis.
• Review of current medications; certain medications may need to be adjusted or stopped.

Procedure Description

1. The procedure begins with the administration of local or general anesthesia.
2. A neck incision is made to expose the targeted artery.
3. The surgeon isolates the artery and clamps it to stop blood flow temporarily.
4. An arteriotomy (opening of the artery) is performed, and the atherosclerotic plaque is carefully removed from the arterial wall.
5. A patch graft may be applied to widen the artery and ensure a smooth, open pathway.
6. The artery is then closed, the blood flow is restored, and the incision is sutured.
7. The surgical site is monitored for proper blood flow and any immediate complications.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is usually performed in a hospital's surgical suite.

Personnel

• Surgeons, specializing in vascular surgery.
• Anesthesiologists, to manage anesthesia.
• Surgical nurses and technicians to assist with the operation.

Risks and Complications

• Risks: bleeding, infection, nerve injury, stroke, heart attack.
• Rare complications: restenosis (re-narrowing of the artery), reaction to anesthesia, blood clots.
• Management: Close monitoring, medications, prompt medical interventions if issues arise.

Benefits

• Improved blood flow to the brain and upper extremities.
• Significant reduction in the risk of stroke.
• Many patients experience immediate relief of symptoms after recovery.

Recovery

• Post-surgery, patients may stay in the hospital for 1-2 days for monitoring.
• Instructions for care of the incision site, activity restrictions, and medications.
• Gradual return to normal activities over several weeks.
• Follow-up appointments to ensure proper healing and assess arterial health.

Alternatives

• Medical management with medications (e.g., antiplatelets, statins).
• Less invasive procedures such as carotid artery stenting.
• Pros and cons: Medication management is less invasive but may be less effective for severe stenosis; stenting is less invasive but may carry different risks.

Patient Experience

• During the procedure: Undetectable if under general anesthesia; local anesthesia may involve some awareness but no pain.
• After the procedure: Mild to moderate discomfort or pain at the incision site, manageable with prescribed pain relievers.
• Full recovery may take several weeks, with gradual resumption of normal activities based on the surgeon's advice.