What is an Endarterectomy?

Arteries carry blood from the heart to the brain and other parts of the body. If an artery becomes blocked, the blockage can prevent blood, oxygen, and essential nutrients from being transported to one or more areas of the body. If the carotid artery becomes blocked, for example, blood deprivation may lead to a stroke. In a procedure called an endarterectomy, arterial blockages are removed to prevent such events from occurring.

Arteries become blocked as a result of the build-up of plaques, which are deposits of fat, cholesterol, and other material. These deposits can significantly reduce the diameter of the artery, and make it hard and rigid. This condition, referred to as atherosclerosis or hardening of the arteries, can reduce blood flow to the brain. Sometimes, a piece of plaque from the carotid artery breaks off and may travel to the brain and become lodged in a small vessel. This may result in a stroke.

To reduce the risk of stroke in an individual with atherosclerosis, a carotid endarterectomy procedure may be performed. During this procedure, plaque deposits are removed from the artery. This can reduce the risk of stroke, and can prevent the occurrence of transient ischemic attacks, or mini-strokes. Transient ischemic attacks, which occur when blood flow to the brain is partially blocked by plaque, are considered a warning sign that a major stroke may be about to occur.

Before an individual can undergo an endarterectomy, he or she must first undergo diagnostic tests such as an arteriography or ultrasound. These tests help doctors and surgeons determine exactly where the arterial plaque is located. The surgeon can then refer to the test results to ensure that he or she makes an incision in a spot which allows the best possible access to the arterial blockage.

The endarterectomy begins after the patient is anesthetized, when the surgeon makes an incision at the site of arterial blockage. If the carotid artery is blocked, for example, the incision is made in the neck. Once an incision has been made the artery is exposed, and clamps are placed to prevent loss. Sometimes a bypass is created using synthetic material so that blood can continue to flow as normal.

The surgeon then makes an incision in the artery and removes the blockage. This can be a delicate process as it is important to ensure that the entire blockage is removed. Any small pieces which remain may break off the artery wall and cause a full blockage in another smaller vein. Following removal of the blockage, the artery is closed. If the artery is damaged, the surgeon may patch it with synthetic graft material or a “patch” taken from the patient’s own leg vein. The entire endarterectomy procedure usually takes no more than two hours. Patients stay in hospital at least two days after surgery, and once home will require several weeks of rest.