What is endarterectomy? Let's talk about it!

Have you ever thought that the blood vessels inside our bodies are like the water pipes in a house? Just as over time, dirt and rust build up inside water pipes and block the flow of water, things like oil and fat can also build up inside our blood vessels and block the flow of blood. That's what we call `Endarterectomy`, a surgical procedure to clean out such a blocked blood vessel. Today, we will talk about this in simple terms.

Simply put, what is Endarterectomy?

Endarterectomy (pronounced: en-da-te-rek-to-me) is a surgical procedure to reopen blocked or narrowed arteries. In this procedure, doctors remove plaque , a thick layer of fat, calcium, and plaque that has built up inside your arteries.

Just like cleaning out the dirt inside a water pipe and allowing the water to flow smoothly again, after this surgery, blood circulation in the blood vessels is restored. This greatly reduces the risk of dangerous conditions like blood clots and stroke .

This surgery is usually performed as a treatment for a condition called atherosclerosis. This is when plaque builds up inside the blood vessels, causing them to gradually harden and narrow. This surgery is usually recommended for symptomatic, moderately severe cases of blocked arteries.

There are two main conditions treated with this surgery:

• Peripheral Artery Disease (PAD): This is a buildup of plaque in the arteries that supply blood to your legs or arms. This can cause your legs to hurt when you walk, wounds to heal slowly, and sometimes even tissue death (gangrene).
• Carotid Artery Disease: This is a serious condition. It is caused by plaque buildup in the two main arteries in the neck that carry blood to the brain. If left untreated, it can lead to a stroke or a transient ischemic attack (TIA).

What are the types of endarterectomy surgeries?

The type of surgery varies depending on where in your body the blood vessel is blocked. Check out the table below to make this easier for you.

How should I prepare before surgery?

Before this surgery, the doctor will do several tests to find out exactly how blocked your blood vessel is.

• Doppler Ultrasound: This uses sound waves to see where blood vessels are blocked and the amount of blood flowing.
• CT Angiography: In this, a special liquid (contrast dye) is injected into a vein in your arm, and a CT scan is used to take a three-dimensional (3D) picture of your blood vessels.
• Angiography: In this procedure, a special liquid is injected directly into the blood vessel and X-ray images are taken.
• Magnetic Resonance Angiography (MRA): Uses magnets and radio waves to take pictures of blood vessels.

In addition, your doctor will give you instructions on how to prepare for the surgery. You may be asked to temporarily stop taking certain medications, such as blood thinners (anticoagulants). Sometimes, you may be asked to start taking medications such as aspirin.

You will also need to fast for a few hours before the surgery. The anesthesiology team will tell you exactly what to do. You may also have tests like an `Echocardiogram` or `Stress Test` to check the health of your heart.

Who cannot have this surgery?

Some people with certain medical conditions are at higher risk for this surgery, so doctors do not recommend it for them. For example:

• If you have a severe heart condition that is uncontrollable (congestive heart failure).
• If you have recently had a heart attack.
• If you have symptoms of heart disease that cannot be treated.
• If you have severe lung disease such as emphysema or COPD.
• If you have previously received radiation treatment to the area where the surgery will be performed.
• If there is an infection in that area.

How is the surgery done?

You will be given anesthesia so that you will not feel any pain during the surgery. Most often, you will be given general anesthesia. This means that you will be unconscious. However, in some cases, especially when cleaning the arteries in your neck (carotid endarterectomy), you may be kept awake and only numbed in that area (local anesthesia) during the surgery because it is necessary to monitor your brain activity.

During the surgery, the doctor:

1. An incision is made by cutting the skin over the blocked blood vessel.

2. The blood vessel is opened and the layer of `plaque` inside is carefully removed.

3. The blood vessel is stitched back together and closed. Sometimes, to stop the area from narrowing again, an artificial `patch` (patch) or a piece of healthy vein taken from another part of your own body is used to widen the area a little.

4. Finally, the skin incision is closed and sutured.

Benefits, risks, and recovery time

The main benefit of this surgery is that it unclogs the blocked blood vessel and restores blood flow. This significantly reduces leg pain, non-healing wounds, and especially the risk of stroke. The results of this surgery usually last for years.

As with any surgery, there are some risks involved, but the likelihood of these occurring is low.

• Bleeding
• Heart disease, such as heart attack
• Infections
• Nerve damage (often temporary)
• Narrowing of the same vein that underwent surgery
• `Stroke`

How long does it take to heal?

The length of time you will stay in the hospital depends on the type of surgery performed.

• Carotid (neck vein) surgery: about a day.
• For femoral (leg vein) surgery: About two to four days.
• Aortic (abdominal artery) surgery: about a week.

You will be asked to come in for a follow-up about four weeks after surgery. Most people can return to work after this follow-up. However, if you have a job that requires heavy lifting, it may take a month or two for you to fully recover.

What time should I call the doctor?

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

• Chest pain
• Difficulty breathing
• If you feel feverish or have a cold
• If you feel numbness or weakness at the incision site
• If there is swelling, redness, or pus-like fluid around the incision
• Changes in vision, slurred speech, or drooping of one side of the face
• If nausea or vomiting occurs

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