An endarterial procedure is a type of surgery performed within or on the inner surface of an artery. It addresses issues directly affecting the interior lining of a blood vessel, aiming to restore proper blood flow through obstructed arteries.
The Underlying Cause for an Endarterial Procedure
The primary reason for an endarterial procedure is atherosclerosis, a condition characterized by the gradual buildup of plaque inside the arteries. This plaque is a sticky substance composed of fatty deposits, cholesterol, cellular waste products, and calcium. As these deposits accumulate, they cause the artery walls to thicken and harden, narrowing the internal passage through which blood flows.
This narrowing, or stenosis, reduces the amount of oxygen-rich blood that can reach organs and tissues. If a piece of plaque breaks off or a blood clot forms on the plaque, it can completely block the artery or travel to other parts of the body, potentially causing a stroke or peripheral artery disease.
The Endarterectomy Procedure
An endarterectomy is a surgical procedure designed to remove obstructive plaque from the inner lining of an artery. A common example is a carotid endarterectomy, performed on the carotid arteries in the neck that supply blood to the brain. This operation typically takes one to two hours to complete, aiming to restore adequate blood flow and reduce the risk of stroke.
During the procedure, a surgeon makes an incision, usually about 4 inches long, in the neck to access the affected carotid artery. The artery is then temporarily clamped both above and below the plaque buildup to stop blood flow through that section. In some cases, a small tube, called a shunt, may be inserted to temporarily reroute blood flow around the blocked section, maintaining circulation to the brain during the operation.
Once the artery is isolated, the surgeon makes a cut along its length to expose the plaque. Using specialized instruments, the fatty, waxy plaque material is carefully peeled or scraped away from the arterial wall. After the plaque is removed, the artery is meticulously closed with sutures, often with the addition of a patch graft made from a vein or synthetic material to widen the artery and help prevent future narrowing. Blood flow is then restored through the now-cleared artery, and the incision in the neck is closed.
The Recovery Process
Following an endarterectomy, patients are typically monitored in the hospital for approximately one to two days. During this immediate postoperative period, medical staff closely observe blood pressure, heart rate, and the surgical incision to ensure a stable recovery. Some discomfort or soreness in the neck around the incision site is common and can be managed with pain medication.
Upon returning home, patients should continue to rest and gradually increase their activity levels. Wound care usually involves keeping the incision clean and dry, often with mild soap and water, until it heals. Numbness along the jawline or near the earlobe may occur due to the incision, but this sensation often improves over several months.
Long-term management after an endarterectomy involves lifestyle adjustments and often includes medication. Patients are typically prescribed antiplatelet medications, such as aspirin, to help prevent blood clots and future plaque buildup. Adopting a heart-healthy diet, engaging in regular physical activity, and avoiding smoking are also recommended to support long-term arterial health and reduce the risk of recurrent blockages.