Davao Medical School Foundation. Inc.

Medical School Drive, Bajada, Davao City

College of Nursing

In partial fulfillment of the requirements in

NCM 104 RLE

A reading on

ENDARTERECTOMY

SUBMITTED TO:

Mrs. Mary Ann C.Casas RN, MAN

Clinical Instructor

SUBMITTED BY:
Yasierah K.Agalin St.N
BSN 3 Student

DATE: February 21, 2017

ENDARTERECTOMY
Definition

Endarterectomy is an operation to remove or bypass the fatty deposits, or blockage, in an

artery narrowed by the buildup of fatty tissue.

Purpose

Removing the fatty deposits restores normal blood flow to the part of the body supplied by
the artery. An endarterectomy is performed to treat cerebrovascular disease in which there
is a serious reduction of blood supply to the brain (carotid endarterectomy), or to treat
peripheral vascular disease (impaired blood supply to the legs).

Endarterectomy is most often performed on one of the two main arteries in the neck (the
carotids) opening the narrowed arteries leading to the brain. When performed by an
experienced surgeon, the practice is extremely effective, reducing the risk of stroke by up
to 70%. Recent studies indicate it is effective in preventing stroke, even among those
patients who had no warning signs except narrowed arteries detected by their doctors on a
routine exam.

Precautions

Before the surgery, a full medical exam is usually done to assess any specific health
problems, such as diabetes, high blood pressure, heart disease, or stroke. If possible,
reversible health problems, such as cigarette smoking or being overweight, should be
corrected.

Description

Carotid artery disease

Every person has four carotid arteries (the internal and external carotids on each side of
the neck) through which blood from the heart moves into the brain. If one of these arteries
becomes blocked by fat and cholesterol, the patient may have a range of symptoms,
including:

weakness in one arm, leg, half of the face, or one entire side of the body

numbness or tingling

paralysis of an arm, leg, or face

slurred speech

dizziness

confusion, fainting, or coma

 stroke

Removing this fatty buildup, or bypassing a blocked segment, may restore blood flow to the
brain, eliminate or decrease the symptoms, and lessen the risk of a stroke.

Peripheral vascular disease

When the blood vessels in the legs (and sometimes the arms) become narrowed, this can
restrict blood flow and cause pain in the affected area. In severe cases, the tissue may die,
requiring amputation.

The narrowing is usually caused by buildup of fatty plaques in the vessels, often as the
result of smoking, high blood pressure, or poorly-controlled diabetes mellitus. The vessels
usually narrow slowly, but it's possible for a blood clot to form quickly, causing sudden
severe pain in the affected leg or arm.

Procedure

Endarterectomy is a delicate operation that may require several hours. The surgeon
begins by making an incision over the blocked artery and inserting a tube above and below
the blockage to redirect the blood flow while the artery is opened.

Next, the surgeon removes the fat and cholesterol buildup, along with any blood clots that
have formed, with a blunt dissecting instrument. Then the surgeon bathes the clean wall in
salt solution combined with heparin, an anticoagulant. Then the surgeon stitches the artery
just enough so that the bypass shunt tube can be removed, and then he/she stitches the
artery completely closed. After checking to make sure no blood is leaking, the surgeon next
closes the skin incision with stitches.

The operation should improve symptoms, although its long-term effects may be more
limited, since arterial narrowing is rarely confined to one area of one artery. If narrowing is a
problem throughout the body, arterial reconstructive surgery may be required

The total cost of an endarterectomy, including diagnostic tests, surgery, hospitalization, and
follow-up care, will vary according to hospital, doctor, and area of the country where the
operation is performed, but a patient can expect to pay in the range of $15,000. Patients
who are very young, very old, or very ill, or who need more extensive surgery, may require
more expensive treatment.

Preparation

Before surgery, the doctor pinpoints the location of the narrowed artery with an x-ray
procedure called angiography. For surgery to be effective, the degree of narrowing should
be at least 70%, but it should not be total. Patients undergoing angiography are given a
local anesthetic, but the endarterectomy itself requires the use of a general anesthesia.

Aftercare
After the surgery, the patient spends the first two days lying flat in bed. Patients who have
had carotid endarterectomy should not bend the neck sharply during this time. Because the
blood flow to the brain is now greatly increased, patients may experience a brief but severe
headache, or lightheadedness. There may be a slight loss of sensation in the skin, or
maybe a droop in the mouth, if any of the nerves in the neck were lightly bruised during
surgery. In time, this should correct itself.

Risks

The amount of risk depends on the hospital, the skill of the surgeon, and the severity of
underlying disease. Patients who have just had an acute stroke are at greatest risk. During
carotid artery surgery, blood flow is interrupted through the artery, so that paralysis and
other stroke symptoms may occur. These may resolve after surgery, or may result in
permanent stroke. Paralysis is usually one-sided; other stroke symptoms may include loss
of half the field of vision, loss of sensation, double vision, speech problems, and personality
changes. Risks of endarterectomy to treat either carotid artery or peripheral vascular
disease include:

reactions to anesthesia

bleeding

infection

blood clots

Normal results

The results after successful surgery are usually striking. The newly opened artery should
help to restore normal blood flow. In carotid endarterectomy, surgery should prevent the
risk of brain damage and stroke. However, the buildup of fat and cholesterol usually affects
all arteries, not just the one that was operated on. Affected arteries in other parts of the
body may be equally clogged and potentially dangerous. Even arteries that were operated
electively will likely begin to clog up again after the surgery.

For this reason, lifestyle changes (no smoking, low fat, low cholesterol diet) are important,
especially if diet and lifestyle contributed to the development of the problem in the first
place.

KEY TERMS

Carotid arteries The four principal arteries of the neck and head. There are two common
carotid arteries, each of which divides into the two main branches (internal and external).

Diabetes mellitus A disorder in which the pancreas doesn't produce enough (or any)
insulin. As a result, the blood levels of sugar become very high. Among other things,
diabetes can lead to the breakdown of small blood vessels and a high risk of
atherosclerosis and high blood pressure.

Stroke Damage to the part of the brain caused by an interruption of the blood supply. In
some cases, small pieces of plaque in the carotid artery may break loose and block an
artery in the brain. A narrowed carotid artery also can be the source of blood clots travelling
to the brain, or the artery can become completely clogged, blocking all brain blood flow.

References: Encyclopedia (2017). endarterectomy. Retrieved 20 February, 2017, from

http://www.encyclopedia.com/medicine/divisions-diagnostics-and-
procedures/medicine/endarterectomy

REACTION:

This article introduces another surgical management for coronary artery disease called
endarterectomy, or the removal of plaque from inside an artery, I found this article helpful to me
in understanding more about how this surgery is done, the article gave a profound explanation
of the benefits, risks and what to expect after this procedure as well as the description of what
happens in this procedure, and with further research, I read about how it helped relieving the
symptoms of CAD in many patients

As a student nurse, knowing more about the surgical procedure of my patient can help me in
providing good care to my patient and watching out for any possible complications, I found this
article to be very relevant to my study as I have my duty in the operating room, I havent
assisted in this kind of surgery yet and I needed to know more in case I encountered similar
cases in the future , This Reading supplemented the learning I have acquired from my duty
exposure and my clinical instructor and helped me appreciate the importance of technology in
health care, thanks to this surgery, many patients can avoid having stroke or other
complications of CAD, I understand that its my responsibility as a member of the health care
team to be fully equipped with knowledge all about my patients condition, not only while I am
still a student, but until I graduate and become a registered nurse, learning is a continuous
process and the more duty exposures I have, the more competent I become as a nurse.