Let's learn simply about Endarterectomy, a surgery that removes 'fatty deposits' inside blood vessels.

You must have noticed that as the water pipes in our homes get old, they get clogged with dirt and rust. Similarly, the blood vessels in our bodies, the tubes that carry blood, can become clogged with various things over time. When a blood vessel becomes clogged, blood flow is disrupted. In such cases, the procedure to remove the clogged things through surgery and clean the blood vessel is simply called ``Endarterectomy``.

What is Endarterectomy? What exactly happens?

Simply put, an endarterectomy is a surgical procedure to reopen blocked or narrowed arteries. Plaque is a hard, sticky layer of fat and calcium that builds up inside our blood vessels. It's like rust forming on a water pipe. In this surgery, doctors open up the blood vessel and scrape away the plaque that has built up inside.

When plaque is removed in this way, the space inside the blood vessel increases. This allows blood to flow properly again. This can greatly reduce the risk of blood clots and serious conditions like stroke .

This surgery is usually performed when the condition known as atherosclerosis, which is a buildup of plaque in the blood vessels, becomes severe, especially in those who are showing symptoms.

The main conditions treated with this surgery are:

• Peripheral Artery Disease (PAD): This is when plaque builds up in the arteries that carry blood to your legs or arms, blocking them. This can cause pain in your legs when you walk, wounds that don't heal, and in the worst cases, tissue death (gangrene).
• Carotid Artery Disease: This is the buildup of plaque in the two main arteries in our neck that carry blood to the brain. If these arteries become narrowed, blood flow to the brain can be cut off, leading to stroke, transient ischemic attack (TIA), or temporary loss of vision.

What are the types of endarterectomy surgeries?

There are several types of this surgery depending on where it is performed. To make it easier for you to understand, let's look at it this way.

How do you prepare before surgery?

Before you undergo this surgery, the doctor will perform several tests to determine exactly how much and where the blockage in the blood vessel is.

• Doppler ultrasound: A scan that uses sound waves to look for blood flow and blockages.
• CT angiography: Uses special X-rays and a contrast dye to create three-dimensional (3D) images of blood vessels.
• Angiography: A dye is injected directly into an artery and X-rays are used to take pictures of the blood vessels.
• MRA (Magnetic Resonance Angiography - MRA):Detailed images of blood vessels are obtained using magnets and radio waves.

After these tests, your doctor will give you instructions on how to prepare for surgery. You may be asked to temporarily stop taking certain medications, such as blood thinners. You may also be asked to start taking certain medications, such as aspirin. You should do all of this exactly as your doctor tells you.

You will also need to fast (not eat or drink anything) for a few hours before the surgery. The anesthesia team will give you specific instructions about this.

How is the surgery done?

You will be given anesthesia to prevent you from feeling any pain during the surgery. Most people are given general anesthesia. This means you will be asleep during the surgery. However, sometimes, especially in a surgery like a carotid endarterectomy, you may be kept awake and only the area in question will be numbed (local anesthesia) to make it easier to observe brain activity.

Here's a step-by-step breakdown of what happens during the surgery:

1. Skin incision: A small incision is made in the skin directly over the blocked artery.

2. Plaque removal: The artery is opened and the layer of plaque deposited inside is carefully scraped away.

3. Closing the artery: The artery is then stitched shut. Sometimes, a small patch is sewn into place to stop the artery from narrowing again. This patch can be made artificially or can be a piece of tissue taken from another vein in your own body.

4. Skin closure: Finally, the skin incision is closed with stitches.

A Carotid Endarterectomy usually takes about an hour or two. The time for other types of surgery may vary.

What are the benefits and possible risks of surgery?

Main advantages:

• The blockage is removed and the blood vessel is restored to normal.
• As blood circulation returns to normal, things like leg pain and non-healing wounds begin to heal.
• The risk of stroke is significantly reduced.
• In most cases, the results of surgery last for years.

Possible risks:

As with any surgery, there are minor risks involved.

• Bleeding
• Heart problems such as heart attack
• Infectious conditions
• Nerve damage (often temporary)
• Re-narrowing of the artery after surgery
• Paralysis

But for most people, the risk of serious complications is very low.

How long does it take to recover after surgery?

The length of time you will stay in the hospital after surgery will vary depending on the type of surgery performed.

After you go home, it is very important to rest and take your medication as prescribed by your doctor. You will be asked to come to the clinic for a follow-up visit in about 4 weeks. The incision will then be examined. Most people can usually return to work after this clinic visit.

But if you are someone who does heavy lifting, you will need to rest for a month or two until you are fully healed. Especially if you have had abdominal surgery, it is not a good idea to lift more than 5 kilos for two months.

When should you call the doctor immediately?

If you experience any of the following symptoms after your surgery, notify your doctor immediately or go to the Emergency Department (ETU) of the nearest hospital.

• Chest pain
• Difficulty breathing
• If you feel feverish or have a cold
• If there is swelling, redness, or pus-like fluid coming out of the incision site
• If you feel numbness or weakness in your body
• If you experience changes in vision, slurred speech, or drooping on one side of your face
• Nausea or vomiting