Name of the Procedure:

Reoperation, Carotid, Thromboendarterectomy (more than 1 month after original operation)

Summary

A reoperation carotid thromboendarterectomy is a surgical procedure performed to remove a blockage in the carotid artery, which supplies blood to the brain, that has reoccurred more than one month after an initial surgery.

Purpose

The procedure is intended to:

• Address stenosis (narrowing) or occlusion (blockage) in the carotid artery.
• Prevent the risk of stroke or transient ischemic attack (TIA).
• Restore adequate blood flow to the brain.

Indications

This procedure is typically indicated if:

• There is recurrent stenosis or occlusion of the carotid artery following the initial thromboendarterectomy.
• The patient exhibits symptoms such as transient ischemic attacks (TIAs), minor strokes, or other neurological deficits.
• Diagnostic imaging shows significant re-narrowing of the artery.

Preparation

Preparation for the procedure generally includes:

• Fasting for a certain period before the operation.
• Stopping or adjusting certain medications, under doctor's supervision.
• Preoperative diagnostic tests like carotid ultrasound or angiography to assess the artery.
• A thorough health evaluation to ensure the patient can safely undergo surgery.

Procedure Description

1. Anesthesia: The patient is administered general anesthesia.
2. Incision: A surgical incision is made in the neck over the artery.
3. Exposure: The area of the carotid artery to be treated is exposed.
4. Removal of Blockage: Plaque is carefully removed from the inner lining of the carotid artery.
5. Closure: The artery and incision are then closed, sometimes with a patch to widen the artery and prevent re-narrowing.
6. Monitoring: The patient is closely monitored throughout the procedure.

Tools may include surgical instruments, a retractor, and potentially a microscope or endoscope for better visualization.

Duration

The procedure typically takes 1 to 2 hours to complete.

Setting

This procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Vascular surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

Common and rare risks include:

• Bleeding or hematoma formation
• Infection
• Nerve injury, leading to issues like hoarseness
• Stroke or transient ischemic attack
• Recurrent carotid artery stenosis

Benefits

• Improved blood flow to the brain
• Reduced risk of strokes
• Relief of neurological symptoms Benefits are typically observed soon after recovery from surgery.

Recovery

• Post-procedure monitoring in a recovery room.
• Pain management with prescribed medications.
• Keeping the head elevated.
• Avoiding strenuous activities for a few weeks.
• Follow-up appointments to monitor healing and re-evaluate the artery with imaging tests.

Alternatives

• Medical management with medications like antiplatelet agents or statins.
• Carotid artery stenting, a less invasive procedure to widen the artery. Pros of alternatives: Less invasive, shorter recovery. Cons: May not be as effective in severe cases; risk of stroke during stenting.

Patient Experience

During the procedure, the patient will be under general anesthesia and won't feel pain. Post-operative discomfort can be managed with pain relief medications, and any swelling or bruising should subside within a few days to weeks. Emotional and physical support from healthcare providers will ensure comfort and a smooth recovery.