Vasculary Surgery



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Overview

 


What Is Carotid Endarterectomy ?

Carotid endarterectomy is an operation during which your vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates a substance called plaque from your artery and can restore blood flow.

As you age, plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up this plaque. As more plaque builds up, your arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Eventually, enough plaque builds up to reduce blood flow through your carotid arteries, or to cause irregularities in the normally smooth inner walls of the arteries.

Your carotid arteries are located on each side of your neck and extend from your aorta in your chest to enter the base of your skull. These important arteries supply blood to your brain.


How do I prepare ?

Your physician or vascular surgeon will give you the instructions you need to follow before the surgery, such as fasting.

Before your vascular surgeon performs a carotid endarterectomy, he or she may want to determine how much plaque has built up in your arteries. The most common test used for this purpose is duplex ultrasound. Duplex ultrasound uses painless sound waves to show your blood vessels and measure how fast your blood flows. It can also determine the location and degree of narrowing in your carotid artery.

 Other tests your vascular surgeon may use include:

  • Computed tomography (CT) scan
  • Computed tomographic angiogram (CTA)
  • Magnetic resonance angiography (MRA)
  • Angiography (or arteriography)


Am I Eligible For Carotid Endarterectomy ?

You are eligible for the procedure if you have severe narrowing of your carotid arteries, especially if you are experiencing TIAs and are in reasonably good health otherwise. You may be eligible, but at a relatively increased risk,

if you have:

  • Had a large stroke without recovery
  • Widespread cancer with a life expectancy of less than two years
  • High blood pressure that has not been adequately controlled by lifestyle changes or medications
  • Unstable angina (chest pains)
  • Had a heart attack in the last six months
  • Congestive heart failure
  • Signs of progressive brain disorders, such as Alzheimer's disease


Am I At Risk For Complications During A Carotid Endarterectomy ?

Having had a stroke in the past increases your chances for complications to a varying degree depending upon its severity, how recently it occurred, and the degree of recovery. Other factors that may increase your chances for problems during a carotid endarterectomy, in addition to those conditions listed above,

 include:

  • The presence of a serious disease, such as severe heart or lung disease
  • Plaque your surgeon cannot reach through surgery
  • Severe blockage in other blood vessels that supply blood to your brain, such as the carotid artery on the other side
  • Having a new blockage in a previous carotid endarterectomy on the same side (recurrence)
  • Diabetes
  • Cigarette smoking


Are There Any Complications ?

You may have complications following any surgical procedure. A stroke is one possible complication following a carotid endarterectomy. This risk is very low, ranging between 1 and 3 percent. Another unusual complication is the re-blockage of the carotid artery, called restenosis, which may occur later, especially if you continue to smoke cigarettes.  The chance of developing a restenosis severe enough to require another carotid endarterectomy is usually about 2 to 3 percent. Temporary nerve injury, leading to hoarseness, difficulty with swallowing, or numbness in your face or tongue, is another uncommon, but possible, complication. This usually clears up in less than 1 month and usually doesn't require any treatment. However, the chance of any of these unusual complications is much less than the risk of stroke if a significant carotid blockage is not adequately treated.






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