What is Carotid Endarterectomy?

Carotid Endarterectomy is an operation that removes plaque formation from the artery in your neck.

The arteries are widened to permit blood flow to the brain by making an incision along the skin folds in the neck.

A shunt (tube) may be used to supply blood to the brain during surgery. The surgery takes one to two hours under general anesthesia. The scarring is minimal and heals quickly.

What causes blockage?

Certain diseases may cause changes in blood flow in the artery. Some of these diseases include:

  • Atherosclerosis (hardening of the arteries)
  • High blood pressure
  • Peripheral vascular disease or peripheral arterial disease (plaque, hardening of the arteries in your arms or legs)
  • Plaque is a deposit of fat, cholesterol and calcium that restricts blood flow causing the artery to become smaller and in some cases closing the artery completely.

Risks involved in a Carotid Endarterectomy

  • There is some risk with any surgery.
  • Risk factors vary with each person.
  • Risks depend on the carotid artery disease and the type of surgery being performed.

Risks involve:

  1. Stroke/TIA: The carotid artery is clamped to allow the surgeon to work in the diseased area. This may cause blood flow to the brain during this time to be insufficient, resulting in an ischemic stroke. To prevent this from occurring, EEG monitoring is used and a shunt (tube) may be used to restore blood flow to the brain during surgery.
  2. Heart Attack: Atherosclerosis may cause narrowing of the coronary artery in the heart. If symptoms of heart disease are present, you may be referred to a cardiologist.
  3. Other: Minor nerve damage that may cause difficulty in swallowing or tongue coordination, skin numbness, swelling and wound infection
Guidelines For: Day Before Surgery: Day Of Surgery: Day After Surgery:
TESTS Blood work, chest X-ray, other tests as needed Blood work as needed Blood work within normal limits for patient
TREATMENTS Physical assessments, prepare neck for surgery, shave and/or cleanse with special soap Vital signs taken, nurse will check incision for drainage and swelling, and check strength in arms, legs, ability to smile, frown, and short-term memory. Incentive Spirometry issued. Incision healing, no complications (bleeding, infection) noted and normal strength in arms and legs
LINES & TUBES Heart monitor, pulse oximetry Heart monitor, pulse oximetry, IV, Foley catheter in bladder, possibly a Jackson Pratt drain to the incision. All monitors removed
MEDICATIONS Medications as ordered by doctor.
YOUR SURGEON SHOULD HAVE INSTRUCTED YOU TO STOP ALL BLOOD THINNERS OR ANTIPLATELETS EXCEPT FOR ASPIRIN
Pain medications, blood pressure medications, antibiotic, IV fluids Patient is educated on when to use pain medication
NUTRITION Nothing to eat or drink after midnight the night before or morning of surgery Begin drinking clear liquids, report any problems swallowing. Diet may be advanced to solid food if no nausea and vomiting. Patient tolerating regular diet and understands any dietary changes that may need to be changed
ACTIVITY Unrestricted Bed rest with head of bed elevated to 30 degrees First day after surgery, out of bed to chair early and then walking in hall with staff prior to being discharged. Patient to follow up with their surgeon in clinic in 2 weeks. Will advise patient when to return to normal activity level.
BLADDER & BOWEL Empty bladder before surgery Urine output measured from Foley catheter by staff Urinary catheter removed early first day after surgery. Patient MUST urinate prior to discharge.
RETURNING HOME Discharge needs discussed Include family or significant other in teaching Patient and family state
understanding of discharge
instructions and know when to notify doctor of changes

After Surgery

During recovery, your nurse will continue to do vascular checks. This consists of checking your extremities for color, temperature, pulse and sensation. You may continue to receive a small amount of oxygen for the first few hours after returning to your room. Report any increases in shortness of breath, chest pain or severe headaches.
The Foley catheter may be inserted during surgery to monitor your urine output. The Foley catheter will remain in place until 6 a.m. the next day.
Intravenous (IV) fluids are given until you are able to orally take food and liquids.
You will remain in bed the first night of surgery with your head elevated 30 degrees. If you have compression stockings on your legs, it will help increase blood flow and decrease your risk of blood clots.

Medication:  Your nurse will give you medication that has been ordered by your doctor. DO NOT take any medications from home while in the hospital. If you need these medications your doctor will order them, and the nurse will administer them to you.

Activity: The first day after surgery you will be expected to be out of bed, in a chair and walking around the unit with a staff member.
It is important that you use your incentive spirometer every 1 to 2 hours while awake. This device will assist in your breathing. You should cough and take deep breaths at least every two hours. These exercises are very important in reducing your risks of getting pneumonia while in the hospital.

Diet:  You will be given a clear liquid diet when you return to your room. As you tolerate food and drink, your diet will be advanced to normal.

Bathing: When bathing, remember not to submerge your incision in a tub bath. Showers are best until your doctor advises you otherwise. Do not apply any lotions, shaving cream, aftershave lotions, powders, colognes or perfumes on your incision. These items increase your risk of infection.

Smoking:  No smoking!  Nicotine causes narrowing of the arteries, which decreases blood flow. Smoking also increases your heart rate and blood pressure.
Alcohol: Drink in moderation. DO NOT mix alcohol with any medication.

GOING HOME
This is a checklist that will help you care for yourself at home.  It is important that you and your family complete the following checklist before leaving the hospital:

  • Review medication information with your nurse
  • Know what problems to report to your doctor and who to call for problems and concerns
  • Know how to care for your wounds
  • Find out any diet changes

THE HEALING PROCESS
Soreness after surgery is normal. It is also normal to feel tired for a few days. Anesthesia will have this effect.  Eating well after surgery is important. A balanced diet will help you heal. Remember you do not heal when you hurt, so if you need your pain medication be sure to take it as prescribed.

With pain medications sometimes comes constipation. If needed, take a stool softener or eat more fruits such as prunes or apples. Use whole wheat bread instead of white bread.  Try bran muffins and cereals with fiber like All Bran.

Drink about eight cups of water a day unless your doctor has limited your fluids.

Try walking for exercise; this will help with movement of your bowels

CARING FOR YOURSELF AT HOME

  • Check your incision every day.
  • You may take showers, but do not take tub baths until your incision is fully healed. Until then, wash it with warm water and soap, and then pat dry.
  • Do not apply anything to your incision.  If Steristrips are used, these may become loose and may fall off before your follow-up appointment, this is normal.
  • Dermabond glue may have been used to seal your incision. It will be shiny and eventuallly turn dark and begin to dry, crack, or become sticky. This should fall off after 4-6 weeks. If not, gently wash your incision with a warm, wet wash cloth and antibacterial soap to help loosen the glue.
  • Report any signs of infection to your doctor. Things to look for are excessive drainage, redness, warmth and swelling.
  • Take your pain medication as ordered.
  • Call your doctor if you experience excessive pain.

GENERAL ACTIVITIES AT HOME
Feeling fatigued when you return home is normal.  Rest is very important the first few days after your surgery. You may take a few short walks during the day, but otherwise resting and napping is helpful for you to regain your energy and helps the healing process.

You should NOT drive for a week to 10 days

No heavy lifting of anything heavier than five pounds

No yard work, sports activities or house cleaning for the first few weeks

No taking any long car or plane rides for the first 4-6 weeks, or until after your first  post-surgical visit to the surgeon’s office.

FOLLOW-UP CARE
Before going home you may be given a follow-up appointment with your surgeon. The appointment will be at least one to two weeks after discharge.  If you have problems prior to your appointment, you may contact your surgeon’s office.

Problems you should report to your doctor:

  • Temperature greater than 101.5 degrees
  • Redness, tenderness or oozing from incisions
  • Pain (not controlled with pain medications)
  • Nausea and vomiting
  • Bowel or bladder problems
  • Shortness of breath
  • Severe headaches not relieved with pain medication
  • Numbness or confusion

MODIFYING YOUR LIFESTYLE
Modifying your lifestyle to decrease your risks of atherosclerosis occurring again will prolong and improve your quality of life, while decreasing your chances of having surgery again.

Recommended lifestyle changes include:

  • Control hypertension and diabetes
  • Stop smoking
  • Exercise regularly
  • Reduce stress in your life
  • Modify your diet

Call 911: If you have any of the following symptoms of a stroke do not call the surgeon’s office! IMMEDIATELY CALL 911!

  • Sudden, severe headaches with no apparent cause
  • Sudden, blurred or double vision or loss of vision
  • New onset weakness, numbness or tingling of the face, arm or leg on one side of the body
  • Slurred speech, loss of speech or difficulty understanding speech
  • Unexplained dizziness, unsteadiness or sudden falling