What is carotid endarterectomy technique?

Your surgeon makes an incision along the front of your neck, opens your carotid artery and removes the plaques that are clogging your artery. Then, your surgeon repairs the artery with stitches or a patch made with a vein or artificial material (patch graft).

What is an endarterectomy and when is this procedure performed?

An endarterectomy is one of the common surgeries doctors can use to treat your narrowed arteries, improve blood flow, and relieve symptoms of PAD. The surgery involves removing fatty substances called plaques from your arteries.

What layers are removed in endarterectomy?

In endarterectomy, the surgeon opens the artery and removes the plaque. The plaque forms and thickens the inner layer of the artery, or intima, hence the name of the procedure which simply means removal of part of the internal layers of the artery.

What suture is used for carotid endarterectomy?

Double-armed 6-0 polypropylene sutures are typically used, though when PTFE patches are used, PTFE suture seems to reduce needle-hole bleeding. Before closure is completed, heparinized saline solution is used to flush the ECA, the ICA, and the CCA. The shunt is removed, and the final few stitches are placed.

What is done during an endarterectomy?

During a carotid endarterectomy, your healthcare provider will surgically remove plaque that builds up inside the carotid artery. He or she will make a cut (incision) on the side of the neck over the affected carotid artery. The artery is opened and the plaque removed.

What is the difference between carotid endarterectomy and angioplasty?

Carotid endarterectomy is the standard treatment for atherosclerotic stenosis of the internal carotid artery. Carotid angioplasty is gaining increasing popularity as a less invasive technique in symptomatic patients with severe (>70%) carotid artery stenosis especially in those with significant co-morbidities.

When is carotid endarterectomy recommended?

When is surgery recommended? The National Institute for Health and Care Excellence (NICE) recommends that people who have had a stroke or TIA and have a moderate or severe stenosis should have a carotid endarterectomy. You should be assessed within a week of the start of your stroke or TIA symptoms.

Where is the incision for a carotid endarterectomy?

Which clamp is removed last during a carotid endarterectomy?

Initial blood flow is established by releasing the clamps on the external and common carotid arteries first. The clamp on the internal carotid is removed last.

What instruments might be used to perform an endarterectomy?

Equipment

• Surgical loupes (×2.5, ×3.5)
• Fine vascular clamps and instruments (ie, a cervical carotid endarterectomy [CEA] set), including detachable occluding clips (eg, Heifetz or Yasargil)
• Short occluding balloons if the vessel is not amenable to clamping.
• Arterial shunts (eg, Javid or Sundt)

What are the side effects of endarterectomy?

What are the risks of a carotid endarterectomy?

• Stroke or TIA.
• Heart attack.
• Pooling of blood into tissue around the incision site causing swelling.
• Nerve problems with certain functions of the eyes, nose, tongue, or ears.
• Bleeding into the brain (intracerebral hemorrhage)
• Seizures (uncommon)

How long is incision for carotid endarterectomy?

The surgeon takes these carotid endarterectomy steps: Makes an approximately 4-inch incision in your neck at the site of the blockage. May use a tiny tube to temporarily reroute blood flow around the blockage or narrowing and isolates the area.

Which is better carotid endarterectomy or stent?

Beyond the periprocedural period, carotid stenting is as effective in preventing recurrent stroke as endarterectomy. However, combining procedural safety and long‐term efficacy in preventing recurrent stroke still favours endarterectomy.

Are stents used in carotid endarterectomy?

Carotid endarterectomy is the main treatment for narrowing of the carotid arteries as it’s very effective. But there’s also an alternative procedure called carotid artery stent placement, or stenting.

Who is a good candidate for carotid endarterectomy?

In conclusion, patients with mild to moderate intracranial disease and severe symptomatic extracranial stenosis are ideal candidates for carotid endarterectomy. For those with moderate stenosis and IAD, endarterectomy is recommended, but for those without IAD, endarterectomy is unlikely to be beneficial.

How big is the incision for a carotid endarterectomy?

What is stump pressure for carotid endarterectomy?

Purpose: A carotid artery stump pressure (SP) of < 50 mm Hg and abnormal electroencephalography (EEG) changes have been suggested as indications for selective shunting in patients undergoing carotid endarterectomy (CEA) under general anesthesia.

What instrument can be used to remove the plaque during a carotid endarterectomy?

— A plaque dissector or Freer elevator can be used to dissect the plaque away from the arterial wall. While the wall of the vessel is being held with a fine vascular pickup, the elevator is used to develop a plane between the carotid wall and the plaque.

Is carotid endarterectomy a high risk surgery?

CEA can be safely performed in patients deemed at high risk, including those aged 80 years or older and others with significant comorbid conditions, with combined stroke and mortality rates comparable to those found in randomized trials, ie, the Asymptomatic Carotid Atherosclerosis Study and the North American …

What is the success rate of carotid endarterectomy?

Results— A total of 6169 CEAs in 5808 patients were registered, with a median time at risk of 5.1 (range, 0.1 to 11.8) years. The indication for CEA was asymptomatic stenosis in 10.8% of the patients. Survival after CEA for asymptomatic stenosis was 78.2% after 5 and 45.5% after 10 years.