Endarterectomy - removal of atherosclerotic plaques
Endarterectomy - the general term for surgical removal of the inner wall artery that is affected by atherosclerotic plaques. Normally, the inner wall of the arteries smooth and even. However, the development of atherosclerosis in the arterial wall are formed tumors, consisting of cholesterol, calcium and fibrous tissue. Eventually, the artery narrows and completely normal blood flow stops.
For the treatment of narrowing of the arteries use different techniques such as angioplasty, stenting and endarterectomy.
The methodology of the endarterectomy is that the surgeon holds the incision in the affected area of the artery and scraping the inside of the wall, where there is atherosclerotic plaque. After this operation, the artery widens considerably, thereby recovering the bloodstream. While some treatment is less invasive, in some cases, endarterectomy is more effective, safer and cheaper. Sometimes endarterectomy combined with techniques such as bypass surgery or an extension.
Most often used for endarterectomy restoring blood flow in the carotid arteries. It is used in the treatment of obliterating atherosclerosis of lower limbs, renal artery stenosis, occlusive disease of the aorta and iliac vessels, chronic mesaraic ischemia.
Preparing for endarterectomy
To reduce the risk of blood clots, your doctor may recommend drugs that reduce blood clotting, such as aspirin or klopidrogel (Plavix) for several days. Usually before the operation is necessary to clarify the localization of atherosclerotic plaque. To this end, the patient is taking a number of studies.
The very first method in this series is a duplex ultrasound scan. This method allows the study to assess blood flow velocity in the carotid arteries, the presence of narrowing of their lumen in the form of plaques, blood clots.
Magnetic resonance angiography - a method that allows you to see blood flow in the vessels and their narrowing. To do this using the radio in combination with the magnetic field.
Angiography - This method consists in the fact that the artery is entered and the contrast agent, a series of shots. The method allows to detect narrowing of the arteries, the presence of plaques on their walls.
Usually the patient before surgery prohibits eating for 8 hours. If you are taking any medication, you must tell your doctor.
Are you suitable for endarterectomy?
In the following cases endarterectomy surgery is contraindicated:
high blood pressure
myocardial infarction within the last 6 months
congestive heart failure
signs of progressive brain disease, such as Alzheimer's disease
What is the risk of complications during surgery?
Risk factors for complications during endarterectomy include:
presence of serious concomitant diseases such as cancer
occlusion of the lumen of the vessel by plaque
prior endarterectomy surgery
high blood pressure
congestive heart failure
problems with other vessels of the brain
Preference for choosing a particular method of operation ultimately depends on the current situation.
The procedure of endarterectomy
Features of this operation depends on the location of the affected artery. Typically, the technique is as follows. The surgeon holds the incision in the affected artery. It stands out. Next, the surgeon may enter a special handset - shunt - above and below the narrowing of the arteries. Sometimes it is enough simply to put the clamp on the artery for a short period of time. After this, the artery is opened and a special tool to scrape the plaque or blood clots. Further, after the artery wall is cleaned, it recovered. If the shunt has been imposed, it is removed. Thus restored blood flow in arteries. Sutured wound and applied a sterile dressing.
Postoperative period after endarterectomy
Depending on where the surgery the patient after surgery may remain in hospital for a day. In the first 24 hours the patient needs follow-up. 1 month after surgery, the patient must be evaluated by a surgeon. It is recommended to duplex ultrasound to assess the nature of blood flow. You should immediately seek medical attention in case of the following:
fever, chills, discharge from the wound
increasing swelling and pain
shortness of breath
Necessary to control blood cholesterol, blood pressure, blood sugar readings in the case of treat accordingly.
Complications of endarterectomy
As with any surgery, possible complications after endarterectomy. The most serious of them - it's a stroke. The risk of developing it is 1 - 3%. In addition to stroke, a complication occurs as a re-blockage of the artery, called restenosis. It is most common in those patients who have not given up smoking. The risk of restenosis is 2-3%. Another complication is nerve damage that leads to the breakdown of votes (hoarseness), difficulty swallowing, numbness of the face or tongue. Typically, these complications do not require special treatment and resolved on their own in a month.