Carotid endarterectomy (Endarterectomy) is a surgical procedure primarily used to remove plaques and thrombi from the inner wall of arteries to restore blood flow and prevent severe complications. This operation is commonly performed on patients with carotid or peripheral arterial occlusion. By directly removing the obstructive material, it significantly reduces the risk of stroke, myocardial infarction, or limb ischemia. The surgery is typically indicated for arterial stenosis exceeding 70% or for patients with acute symptoms.
Carotid endarterectomy is divided into two main types: Carotid Endarterectomy (CEA) and Peripheral Arterial Endarterectomy. The mechanism involves the surgeon exposing the outer membrane of the artery, then using specialized instruments to peel away the atherosclerotic plaques from the vessel wall, and repairing the vascular structure to restore normal blood flow.
Unlike other interventional treatments, this surgery directly removes diseased tissue, not only improving stenosis but also eliminating the source of plaque rupture. Carotid surgeries are usually performed under local anesthesia, whereas peripheral arterial surgeries may require general anesthesia.
The main indications include:
This surgery is also applicable for patients after acute stroke, especially if the location of vascular occlusion is clear and the onset is within 24 hours, in which case emergency surgery may be considered to salvage neurological function.
The procedure generally involves three steps: 1. Incising the tissue around the artery after anesthesia; 2. Dissecting and removing the diseased intima; 3. Repairing the vessel structure with sutures. The duration varies depending on the artery location, with carotid surgery lasting approximately 2-3 hours, and peripheral artery procedures potentially longer.
There are no specific drug dosage issues, but anticoagulant therapy is required. Postoperative monitoring of blood pressure and blood flow dynamics is essential, with subsequent treatment plans adjusted based on patient recovery.
Main advantages include:
For patients with lower limb arterial obstruction, the surgery can significantly improve walking distance and tissue survival rate, with relatively stable postoperative recovery.
Possible complications include:
Serious Risks: Thrombus dislodgement during surgery may cause immediate stroke; postoperative thrombosis or arterial rupture requires emergency management. Elderly patients or those with diabetes are at higher risk and require careful assessment of surgical indications.
Contraindications include:
Preoperative assessment should include detailed evaluation of cardiac function and vascular imaging. Close monitoring of blood pressure and neurological function within 24 hours post-surgery is necessary. Patients should avoid strenuous activities for at least 4 weeks.
Requires concurrent use of anticoagulants (such as warfarin), but these should be discontinued 7 days before surgery to reduce bleeding risk. Compared to angioplasty, postoperative management includes lipid-lowering medications to prolong arterial health.
If the patient is also on antiplatelet drugs (such as aspirin), medication timing should be adjusted to prevent intraoperative bleeding.
Large clinical trials show that carotid endarterectomy can reduce the 5-year stroke rate from 13% to 6%. For severe lower limb ischemia, the postoperative improvement rate in claudication exceeds 80%.
Long-term follow-up indicates that the reoperation rate in the surgical group is 30% lower than in the angioplasty group, demonstrating the advantage of structural repair.
Main alternatives include:
When choosing alternatives, factors such as patient age, arterial anatomy, and comorbidities should be considered. For example, elderly patients may prefer angioplasty to reduce anesthesia risks.
Recovery time varies depending on individual constitution and surgical site. Generally, patients stay hospitalized for 1 to 3 days, with some activities (such as short-distance walking) starting within a few days post-surgery. Full recovery of daily activities usually takes 2 to 6 weeks, with gradual increase in activity following medical advice. Heavy lifting and vigorous exercise should be avoided during this period.
What should be done if dizziness or limb weakness occurs postoperatively?These symptoms may be caused by changes in blood flow or temporary nerve compression, but should be reported immediately to the medical team. Doctors may order imaging to confirm vascular status and adjust medication or recommend physical therapy accordingly. Do not self-diagnose; seek medical evaluation promptly.
Is long-term anticoagulant medication necessary after carotid endarterectomy?Doctors will decide whether to prescribe antiplatelet or anticoagulant drugs based on the degree of arterial blockage and risk of complications. Some patients require long-term medication to prevent thrombosis, with doses and drug types regularly evaluated and adjusted. Blood tests to monitor coagulation function are necessary, and concurrent use of other medications that increase bleeding risk should be avoided.
How can restenosis of the artery be prevented after surgery?Postoperative management includes strict control of hypertension, hyperlipidemia, and hyperglycemia, along with smoking cessation to reduce restenosis risk. A low-fat, high-fiber diet, regular exercise, and periodic vascular ultrasound follow-up are recommended. Patients with diabetes or hyperlipidemia should also adhere to medication and lifestyle modifications.
What is the incidence of nerve injury during surgery, and how can this risk be minimized?The risk of nerve injury is approximately 1-3%, often caused by blood flow interruption or plaque fragment migration during surgery. Modern techniques (such as flow-guided catheters or extracorporeal circulation systems) can reduce this risk. Choosing an experienced medical team is also crucial. Preoperative assessment with angiography helps evaluate arterial structure to select the safest surgical approach.
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