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PAD: Endarterectomy

What is an endarterectomy for atherosclerosis/PAD/PVD?

An atherosclerosis endarterectomy is the open surgical removal of plaque from a blood vessel.

Why is this procedure performed? Why do I need this procedure?

The goal of treatment is to eliminate the build-up of plaque in your arteries.

You may need this atherosclerosis endarterectomy procedure if your arteries become too narrowed or blocked from plaque inside the artery walls. If arteries are blocked, blood cannot get through to nourish the tissues, causing the muscles of the lower extremities to cramp and lose strength. In severe cases, you may experience pain at rest or develop ulcers on your feet.

Each patient is evaluated, and treatment will be individualized for the patient's circumstances.

Where is the procedure performed and who performs this procedure?

This atherosclerosis endarterectomy procedure is performed in the hospital surgical suite by a vascular surgeon.

What are the risks and potential complications of the procedure?

Your doctor will discuss the specific risks and potential benefits of the recommended procedure with you.

Endarterectomy usually has no complications, but as with any surgery, there is a risk of complications. An unusual complication is the re-blockage of the artery (restenosis) that may occur later, especially if you smoke cigarettes.

Special precautions are taken to decrease these risks, and there may be other possible risks. When you meet with your doctor, please ask questions to make sure you understand the risks of the atherosclerosis endarterectomy procedure and why the procedure is recommended.

To find out if you are a candidate for this procedure, please call the Vascular Surgery Department at 216.444.4508 or 800.223.2273 ext. 44508.

How do I prepare for the procedure?

A few days before the procedure, pre-procedure tests may be performed to ensure that it is safe to continue with the procedure. You may need to discontinue certain medications before the atherosclerosis endarterectomy procedure. Your health care team will provide specific instructions to help you prepare.

What happens during the procedure?

The endarterectomy will be performed under general anesthesia or regional anesthesia (such as an epidural catheter or nerve block). The surgeon will make an incision at the site of the blockage. He/she may insert a shunt (tube) into the artery above and below the atherosclerotic plaque in order to temporarily reroute blood flow around the blockage or narrowing and isolate the area. The surgeon then makes a length-wise incision along the portion of the artery containing the plaque. The plaque is removed using an endarterectomy spatula, and in some cases, the diseased portions of the vessel are also removed. When the plaque removal is complete, the surgeon stitches the vessel closed and then removes the shunt. In many instances, the artery is closed with a patch that is made out of the patient's own vein or a man-made synthetic material. Blood flow is restored through its normal path.

How long does the procedure last?

The procedure itself generally takes two to three hours, but the preparation and recovery time add several hours. The surgery may require a minimum hospital stay of one to two days.

What happens after the procedure?

You can usually begin normal activities again several weeks after the operation. Your doctor will provide specific guidelines for your recovery.

Are there any side effects of the treatment?

There are few side effects from this procedure, but some patients may experience some mild skin numbness in the area around the incision.

Results of the atherosclerosis endarterectomy procedure

Endarterectomy usually provides good relief of symptoms. Your doctor will discuss the results of the procedure with you. However, unless a healthy lifestyle is adopted, atherosclerosis can recur.

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes.

Cleveland Clinic Heart and Vascular Institute Vascular Medicine Specialists and Surgeons

Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart and Vascular Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:

Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.

Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.

IVC Filter Retrieval Clinic - to make an appointment, call Vascular Medicine at 216.444.4420. Ask for Dr. Bartholomew in the Filter Retrieval Clinic. Your appointment will include a consultation with Dr. Bartholomew and the physicians who will perform the IVC filter retrieval procedure.

You may also use our MyConsult second opinion consultation using the Internet.

The Heart and Vascular Institute also has specialized centers and clinics to treat certain populations of patients:

Learn more about experts who specialize in the diagnosis and treatment of vascular and arterial disease.

Contact

If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Reviewed: 02/16

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