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Visceral Ischemic Endarterectomy

What is an endarterectomy for visceral ischemic syndrome?

An 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 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 of the bowel and gastrointestinal system (intestines).

Acute mesenteric ischemia is a life-threatening condition. In contrast, chronic mesenteric ischemia is characteristically associated with abdominal pain after meals. The onset of pain is usually gradual and progressive. Eventually, this situation results in substantial weight loss and a marked alteration in dietary intake.

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 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. Another possible complication includes the development of a hernia at the site of the incision. In addition, the return of normal bowel function may be slow, and patients may not be able to eat for several days following the surgery.

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 procedure and why the procedure is recommended.

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 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. The surgeon will make an incision in the abdomen, and free the diseased artery from the surrounding tissue. The surgeon will temporarily stop the blood flow in the artery with special clamps. Depending on the location of the blockage, the surgeon may need to stop the blood flow in the aorta, the main blood vessel in the abdomen, temporarily.

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. 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. In some instances, if the blockage extends up to the level of the aorta, the surgeon will need to open the aorta to completely remove the plaque. The aorta will then be suture-closed as well, usually without a patch. Blood flow is restored through its normal path.

How long does the procedure last?

The procedure itself generally takes three to six hours, but the preparation and recovery time add several hours. The surgery may require a minimum hospital stay of seven to 10 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. Some patient will have limited cramping and abdominal pain and some changes in bowel habits for the first few months after surgery.

What are typical results of the procedure?

Endarterectomy usually provides good relief of symptoms. Your doctor will discuss the results of the procedure with you. In addition to following a low-fat diet, eating small, frequent meals is recommended for patients with ischemia. Regular exercise, as well as managing blood pressure, cholesterol and diabetes, also are recommended.

How do I find out if I am a candidate for this procedure?

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. 4-4508.

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