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Endarterectomy

Last updated: May 15, 2019

Summary

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.

Indications

References:[1]

Contraindications

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

Procedure/application

  • 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][3]

Complications

References:[2][4]

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

References

  1. Fedullo PF, Mandel J, Finlay G. Overview of the treatment of chronic thromboembolic pulmonary hypertension. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-the-treatment-of-chronic-thromboembolic-pulmonary-hypertension?source=see_link§ionName=EVALUATION%20FOR%20PULMONARY%20THROMBOENDARTERECTOMY&anchor=H19764309#H19764309.Last updated: July 14, 2016. Accessed: December 7, 2016.
  2. Hansen KJ, Deitch JS. Transaortic mesenteric endarterectomy. Surg Clin. 1997; 77 (2): p.397-407. doi: 10.1016/S0039-6109(05)70557-0 . | Open in Read by QxMD
  3. Lumley JSP, Hoballah JJ. Vascular Surgery. undefined. 2009 .
  4. Haqqani O, Rowe VL. Carotid Endarterectomy. Carotid Endarterectomy. New York, NY: WebMD. http://emedicine.medscape.com/article/1895291. Updated: August 25, 2016. Accessed: December 7, 2016.
  5. Mohler III ER, Fairman RM, Eidt JF, Mills JL, Kasner SE, Collins KA. Complications of carotid endarterectomy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/complications-of-carotid-endarterectomy?source=see_link.Last updated: July 6, 2016. Accessed: December 7, 2016.
  6. Haqqani O, Rowe VL. Endarterectomy. Endarterectomy. New York, NY: WebMD. http://emedicine.medscape.com/article/1895291-overview. Updated: August 25, 2016. Accessed: December 7, 2016.
  7. Fairman RM. Management of Symptomatic Carotid Atherosclerotic Disease. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/management-of-symptomatic-carotid-atherosclerotic-disease.Last updated: October 19, 2016. Accessed: December 7, 2016.
  8. Fairman RM. Management of Asymptomatic Carotid Atherosclerotic Disease. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/management-of-asymptomatic-carotid-atherosclerotic-disease.Last updated: June 24, 2016. Accessed: December 7, 2016.