Endarterectomy

Endarterectomy is a surgical procedure which involves the removal of part of the inner lining of an artery together with the adherent atherosclerotic plaque. The aim of the procedure is to recanalize the occluded vessel and restore vascular supply to the tissue. Endarterectomy is often done on the carotid artery in patients with significant (≥ 80%) or symptomatic (TIA/stroke) carotid artery obstruction to prevent the development of an ipsilateral stroke. Femoral, aortic, and pulmonary endarterectomy are other frequently performed types of endarterectomy. Complications are rare and include injury to adjacent structures, hemorrhage, postoperative wound infection, and development of false aneurysms.

• Symptomatic/significant occlusive arterial diseases
• The indications for each type of endarterectomy are
  • Carotid endarterectomy (CEA): treatment of choice for patients with significant (> 80%) or symptomatic carotid artery stenosis
  • Pulmonary endarterectomy: treatment of choice for chronic thromboembolic pulmonary hypertension
  • Aortic endarterectomy
    • Aortoiliac endarterectomy: for aortoiliac peripheral arterial disease
    • Transaortic mesenteric endarterectomy: for chronic mesenteric ischemia
  • Femoral endarterectomy: for symptomatic lower limb claudication due to femoral artery disease that does not respond to medical management

References:^[1]

• Vessels which show focal dilatations or pre-aneurysmal changes
• Poor surgical candidates
• For specific contraindications for carotid endarterectomy: see carotid endarterectomy

We list the most important contraindications. The selection is not exhaustive.

• Definition: Surgical recanalization of narrowed/occluded arteries by removing the inner arterial lining (endothelial layer and a layer of tunica media)
• Aim: Removal of the occlusive atherosclerotic plaque together/en masse with a portion of the arterial wall in order to restore blood supply to the tissues
• Procedure
  • The artery is exposed, and an arteriotomy is created
  • The plaque, along with the adherent endothelium and inner tunica media, is elevated off the deeper tunica media layer and extracted out of the arteriotomy wound
  • The arteriotomy wound is closed
• Post-procedure: low-dose aspirin for at least 3 months, often indefinitely

References:^[2]

• Intraoperative hemorrhage and postoperative hematoma
• Injury to adjacent structures
• During/after carotid endarterectomy: stroke, hypertension, and hypotension
• Wound infection
• False aneurysms

We list the most important complications. The selection is not exhaustive.