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Features of surgical intervention by the method of endarterectomy

To date, one of the most effective surgical procedures that are performed to eliminate atherosclerosis of the carotid arteries is endarterectomy. As a result of its implementation, the arterial permeability is completely restored. The first such surgery was carried out in the United States in the 50s of the twentieth century. Thanks to this technique, the possibility of a full life for patients and a reduction in the percentage of their mortality after suffering a stroke is restored.

Content

What is endarterectomy

Endarterectomy is a reconstructive-type surgical intervention. The basis of the method is the restoration of normal blood flow through the arterial vessels, which were affected by a disease such as atherosclerosis. The essence of the operation consists in removing an atherosclerotic plaque from the “diseased” artery, which narrows the vessel lumen or closes it.

Scheme of the formation of atherosclerotic plaque in the blood vessel

At the beginning of the formation of atherosclerotic plaque, the blood flow is partially blocked, the fully formed plaque completely blocks the passage of blood through the vascular bed.

Medical statistics says that American clinics annually perform more than 150,000 such operations. In Russia, this technique is also widespread, while the rate of its implementation is several times lower - about 15,000 during the year.

Arterial endothelium in normal conditions should be with a flat and smooth surface. In the process of progression of atherosclerosis, blood flow is impaired due to narrowing of the lumen of the artery. As a result of the further development of the disease, cholesterol, fats, calcium and other blood components are deposited on the walls of the vessel, resulting in atherosclerotic plaques. The latter lead to the loss of elasticity of blood vessels and the appearance of fragility of the vascular wall. Impaired blood flow provokes an insufficient blood supply to all organs and systems.

According to medical practice, endarterectomy is one of the most effective, simple and efficient surgical operations.

Advantages and disadvantages of the technique

The need for endarterectomy medical experts evaluate differently. Some believe that such a surgical intervention can be carried out even as a prophylactic measure, others do not recommend performing the operation until a conservative treatment can be used. However, like other types of on-line access, endarterectomy has its strengths and weaknesses. The number of indisputable advantages of this operation can include the following components:

  • the technique is considered safe unlike other types of surgical intervention;
  • improves blood flow and general blood supply;
  • completely cleans vessels from cholesterol and other substances;
  • helps to reduce the risk of developing a disease such as stroke;
  • in most cases brings positive results.

If we consider the shortcomings of this procedure, then the following facts fall among the weaknesses of endarterectomy:

  1. In some cases during the operation, complications may develop. As a rule, we are talking about damage to the nerve endings. In addition, there may be a risk of stroke.
  2. There is no absolute guarantee that the operated vessel will not be damaged again after some time.

Patients must weigh the pros and cons, before deciding to go under the knife of a vascular surgeon. It is believed that this type of intervention is one of the most difficult to implement. All the risks that occur during its implementation are directly related to the age and health of the patient. An important factor is the experience of the surgeon who performs the operation.

Indications for surgery

This surgical technique is suitable for all patients who have stenosis of the internal carotid artery. Such people, the operation will significantly improve the quality of life.

For the purpose of the operation, there must be serious reasons, which are determined by the attending physician after conducting the appropriate examinations.

Stenosis

If the lumen of the artery is narrowed by more than 70%, endarterectomy is necessarily shown to the patient.

Endarterectomy is indicated in cases where:

  • the patient suffered ischemic attack;
  • the lumen of the artery is narrowed by more than 70%;
  • the results of the surveys show that plaques have ulcerations or their formation occurs in the form of blood clots;
  • atherosclerotic plaques begin to develop on both sides;
  • the patient has previously suffered a stroke (in such cases, surgery may be scheduled to avoid relapse);
  • against the background of hypertension develops atherosclerosis of the carotid arteries.

In Russia, endarterectomy is performed, as a rule, only in cases where drug treatment does not bring the desired results.

Contraindications for endarterectomy

Like other surgeries, endarterectomy is performed only if there are no direct risks to the life of the patient. There are certain contraindications that do not allow the use of this method of surgical intervention.

Endarterectomy is contraindicated if:

  • Myocardial infarction or stroke has been suffered in the last 6 months;
  • the patient has severe hypertension and serious heart disease;
  • there is a development of progressive neurological diseases and disorders;
  • there are comorbidities in a severe form, as the risk of complications increases in the postoperative period;
  • a severe stroke is developing rapidly;
  • there are circulatory disorders in the chronic form, especially if the disease occurs in the second or third degree of severity;
  • the patient has cancer;
  • Alzheimer's disease progresses;
  • age exceeds 70 years.

Preparation for intervention

Before surgery, the patient should be carefully examined, for which are held:

  • blood pressure measurement;
  • determination of lipid profile and blood clotting parameters;
  • electrocardiogram removal;
  • echocardiography;
  • determination of blood glucose levels.

Twelve hours before the operation, it is not recommended to eat and drink.

In order to determine the exact location of the atherosclerotic plaque, the doctor may prescribe the following studies:

  1. Ultrasound of blood vessels. Allows you to determine the degree of filling of the vessel with blood and the localization of the plaque.
  2. Magnetic resonance imaging of the head. Thanks to this method, you can see a clear picture of all the soft tissues and skull. MRI has the highest level of sensitivity of all currently used diagnostic methods.
  3. Computed tomography or angiography. They provide an opportunity to assess the degree of narrowing of the vessel, vyvit all the necessary parameters of cholesterol plaque. Today, angiography is one of the most accurate and informative ways to obtain the necessary data for endarterectomy.

All this allows us to accurately assess the state of the vessels, the degree of blood flow disturbance and other necessary parameters. Completeness of information allows surgeons to properly plan the course of the operation.

What types of operations exist and their technique

Endarterectomy can be performed under both general and local anesthesia. After the patient was given the required dose of anesthesia, the doctor makes a small incision in the neck at the place where the vessel was blocked. After that, the surgeon pinch the artery and incise it. Then make the elimination of plaque. At the final stage, the incision site is stitched. This sequence of actions is the same for each type of endarterectomy. But each of them has its own nuances.

Endarterectomy scheme

First, an incision is made in the arteries, then a plaque is removed, and then the vessel is sutured

To date, use several options for online access. Which of the varieties to apply in a particular case, the surgeon decides directly during the operation after an incision is made on the carotid artery.

Endarterectomy can be done in four ways:

  1. Direct (or open) endarterectomy. It is a classic version of this technique. Cholesterol plaque is removed using a special operating microscope and magnifier. After the necessary incision is made on the artery, the plaque is scraped from its walls. In the place where the surgical intervention and cleaning took place, a special synthetic “patch” is placed. The duration of the operation can be several hours, depending on the severity of the pathological process.
  2. Eversion During an operation using this method, a cross section of the artery occurs, which is affected by cholesterol plaques. Such an artery is turned inside out in order to remove atherosclerotic deposits.
  3. Carotid endarterectomy. Used only to remove carotid atherosclerotic plaques. This technique is particularly difficult to perform, since these vessels supply blood to the human brain. Their blockage and damage can lead to disability or even death of the patient.
  4. Removal of the artery site. It is used in cases of severe atherosclerosis of the artery. When this occurs, it stretches to the required length and stitching. In addition, if atherosclerotic plaque develops to large volumes, the deformed portions of the vessel can be replaced with a synthetic prosthesis.

Postoperative recovery phase

After surgery, it takes time to normalize and restore blood flow. This may take several weeks.

After surgery, the patient is in the hospital from one day to one week, depending on the amount of endarterectomy performed. On the first day the patient is under continuous supervision of medical personnel. If there are any complications or manifestations of negative dynamics of his state of health, he can be transferred to the intensive care unit.

After a day, the therapeutic course of treatment begins. It consists in taking the following medications:

  1. Anticoagulant drugs that contribute to the suppression of the activity of the blood clotting system and do not allow the formation of blood clots. These drugs include Fenilin, Warfarin and Fragmin.
  2. Means that contribute to the improvement of microcirculation. Thanks to them, the blood flow in the vessels is improved and normalized, the vessels and capillaries expand, and the general condition of the blood improves. The following drugs have such properties as Trental and Cavinton.
  3. Nootropic drugs that help stimulate mental activity and improve memory, as well as increase brain resistance to a variety of loads. Often appointed Piracetam, Actovegin and Phenibut.
  4. Analgesics for pain relief: Analgin, Baralgin and others.
  5. Non-steroidal anti-inflammatory drugs to relieve pain and inflammation: Ibuprofen, Paracetamol.
  6. Antibiotics to prevent the development of bacterial infections. Basically use drugs of a wide spectrum of activity such as Azitroks, Amoxicillin and others.
  7. Drugs that prevent thrombosis: Clopidogrel, Aspirin, Cardiomagnyl and others.
  8. Blood pressure regulators: Capoten, Enalapril and others.

Drugs used in the postoperative period - photo gallery

At the end of the week after endarterectomy, the patient is stitched, after which discharge occurs. A person who has undergone an operation of this type must take medication for a long time after discharge. Subsequent observation and examination by a doctor occurs a month after discharge. The specialist evaluates the patient's condition and assigns to undergo the necessary examinations. First of all, the level of blood pressure and the state of the suture are investigated.

When you need to see a doctor during the recovery period

Sometimes, after discharge from a medical facility, the patient may feel a general deterioration of health. Negative symptoms may include the following:

  • Increased body temperature, chills. This may indicate the accession of a bacterial infection.
  • Redness or swelling, development of bleeding at the operated site.
  • Increased pain and the inability to arrest her with painkillers.
  • Nausea, vomiting for two days or more, developing after taking the prescribed drugs.
  • Gastrointestinal problems, diarrhea or constipation.
  • Difficulty urinating.
  • General weakness in the body, dizziness;
  • Vision problems.
  • Problems with the organs of the respiratory system, the occurrence of coughing, shortness of breath or pain in the chest.

If one or more of the above symptoms appear, you should immediately consult a doctor to avoid complications.

What complications may occur after surgery?

Despite the general safety of the operation, there are risks of complications. The main hazards that can occur after endarterectomy include:

  1. Hypotension.
  2. Arterial hypertension.
  3. The appearance of a hematoma at the site of the incision. The use of antiplatelet agents and heparin increases the risk of bleeding and the formation of subcutaneous hematomas. Very rarely, a large hematoma can lead to compression of the internal carotid artery and the cranial nerves adjacent to it. One of the serious complications in the formation of such a hematoma is a violation of the airway, accompanied by the possibility of respiratory asphyxiation or may be a potential source of infection, because of this, most large, hard hematomas of this area need surgical correction.
  4. The development of infection. In such an operation, the penetration of bacteria into the wound is very dangerous for the life of the patient, since the incision is performed directly on the bloodstream. There is a complication most often due to non-compliance with basic rules of hygiene and antiseptics.
  5. Damage to the vagus or injury of the hypoglossal nerve. May be caused by excessive tension, traction or direct injury when using tweezers, clamps. Paralysis of the vocal cord on the side of the operation leads to hoarseness and disruption of the effective cough mechanism. Unilateral damage to the vagus nerve or the recurrent laryngeal nerve can occur without specific symptoms and signs, but can become an obstacle when planning intervention on the carotid artery on the other hand.

  6. Hyperperfusion and hemorrhage in the brain (stroke). Most often manifested in the form of headache, migraine attacks or hemorrhage. As a rule, it manifests itself from two days to a week after the surgical intervention. Such complications can be avoided due to the correct choice of therapeutic treatment and stabilization of the level of blood pressure immediately before the operation. The probability of a stroke ranges from 3 to 6 percent. For comparison, without surgery, the patient is at risk of having a stroke several times more.

In order to avoid the occurrence of any complications in the patient’s state of health, measures are taken to improve the safety of the endarterectomy itself. During its implementation, the patient’s blood pressure is continuously monitored. The required level of it is maintained artificially with the help of special medical preparations during the entire operation, when the vessels are pinched.

To avoid the development of hypertension a few weeks before the scheduled surgical intervention, the doctor may prescribe certain medications. At the same time, quitting smoking makes it easier to postpone the operation and contributes to an easier post-operative period.

Prevention of the development of complications after carotid surgery

Preventive measures should be applied not only during the recovery period, but also in the future. Some patients will have to drastically change their habitual lifestyle in order to maintain their health.

For the normal recovery of the body after surgical intervention, it is necessary to take all medications, unconditionally follow all instructions of the attending physician, follow the prescribed dietary recommendations to prevent the formation of new atherosclerotic plaques. The basis of the diet should be products of plant origin, which contain a large amount of fiber, complex carbohydrates, vegetable fats, vitamins and trace elements. It is necessary to refuse fatty and heavy food.

One of the main preventive measures is to quit smoking and drinking alcohol. It is smokers who are more exposed to the development of possible complications and the risk of recurrence. Doctors recommend spending more time outdoors, taking walks and doing sports. Such simple rules will help to preserve the health of the patient, improve overall health.

Expert opinion on carotid endarterectomy - video

https://youtube.com/watch?v=lQNYaLI2Vvg

Patient feedback

Had an operation 08/29/16 Dz: Endarterectomy carotid eversion left. I am invited for an operation on the right side, but I haven’t really got up since the first operation: I sleep in a half-sitting position, because it throttles in my throat, the ENT doctor says it is edema, and it will pass over time, sometimes up to 3-6 months recovery.

Anonymous

https://health.mail.ru/consultation/2063081/

My husband was operated on March 18th - an eversion carotid endarterectomy on the left. 25. March he removed the stitches, treated seam green and discharged home. By the evening, red and watery blisters appeared on the skin around the suture. Everything grew red and ran out, the redness spread very quickly, the scale of redness increased. I ran to see a surgeon and he prescribed Flucinar ointment mixed in half with a children's cream. The redness gradually began to subside on the 3rd day, we did not touch the suture, it was treated only with furatsilinom, so the redness passed on the 5th day, the bubbles disappeared, but now it became wet and the suture reddened.

Anonymous

https://health.mail.ru/consultation/766188/

Carotid endarterectomy (presentation) - video

Endarterectomy is one of the most effective operations and allows you to restore blood flow to the vessels affected by atherosclerosis. To date, many experts prefer it to her. Surgery allows you to get a positive effect much faster than conservative treatment. So far there are no such medicines that will help completely rid the patient of atherosclerosis and cholesterol plaques. Endarterectomy allows for a short period of time to restore vascular health, prolong the patient’s life and prevent the development of a stroke or myocardial infarction. It is carried out in public hospitals free of charge within the framework of the MLA or funded by the quota of the Ministry of Health of the Russian Federation.

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