Carotid Endarterectomy

WHAT YOU SHOULD KNOW:

Carotid endarterectomy (CEA) is a surgery done to remove plaque (fatty deposits) from inside your carotid artery. The carotid artery is a blood vessel found in both sides of your neck. Plaque may build up inside your carotid artery and decrease blood flow to your brain. A piece of plaque may also break free and cause a stroke.


CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • During your CEA, muscles or nerves near your carotid artery may be damaged. Nerve damage may lead to changes in how you look, or trouble chewing and swallowing. You may bleed more than expected or get an infection. You may have headaches, increased blood pressure, and abnormal heartbeats. Swelling of your surgery site may occur, which could block your airway. A fistula (abnormal connection) may form, which connects your carotid artery to another tissue. You are also at risk of having a heart attack during or after surgery, and this can be life-threatening.

  • You may get a blood clot in your leg, arm, or carotid artery. The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke. After a CEA, your carotid artery may become narrow or full of plaque again. The patch used for your surgery may tear or loosen, causing a large amount of blood loss. People who smoke, have diabetes, or kidney, lung, or heart disease are at a higher risk of problems. If you do not have the surgery, you are at risk for a stroke, which may be life-threatening.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • IV: This is placed in your vein to give you medicine or liquids.

  • Medicines:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Blood thinners: This medicine helps stop clots from forming in your blood. Blood thinners may be given before, during, and after your surgery.

  • Pre-op care: You may be given medicine to make you feel relaxed and sleepy before your surgery. Before the surgery, your head will be slightly turned, facing the opposite direction of your narrowed carotid artery. Your body may be slanted with your head at a level below your heart. You will be given medicine called anesthesia that will keep you comfortable during your surgery. Your blood pressure, temperature, and heart rate will be monitored during surgery.

    • Anesthesia: You will be given one of the following:

      • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

      • Local-regional anesthesia: This is a shot used to numb your surgery area and dull your pain. You may be sleepy, but you will stay awake during your surgery.

    • Monitoring:

      • Arterial doppler: This is placed over your artery to check the blood flow going to your brain.

      • Electroencephalogram: This is also called an EEG. It uses small pads (electrodes) placed on your head to show brain activity on a monitor.

      • Somatosensory evoked potential: This is a device used to measure how your brain reacts to sound or touch.

      • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.

      • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

During your surgery:

  • You will be given anesthesia to keep you free from pain during your surgery. Your blood pressure, temperature, and heart rate will be monitored during surgery. Your skin over your carotid artery will be cleaned. An incision is made to open your neck and reach your carotid artery. Your carotid artery may be clamped in certain areas to stop your blood from flowing through it. Your carotid artery will then be cut open and the plaque will be removed.

  • Once the plaque is removed, your artery will be closed or put back together with stitches. A man-made patch or a piece of your own vein may also be used to close your artery. The clamps will be removed and the blood flow through your carotid artery will be checked. A drain may be put under your skin to remove extra blood and fluid from around your artery. Your skin will be closed with stitches and covered with a bandage. The bandage will help keep your surgery area clean and dry to prevent infection.

After your surgery:

You may be taken to a recovery room or your hospital room where caregivers will check you often. You may be attached to monitors that your caregivers can watch outside your room. Your head will be kept straight for 24 hours after surgery to reduce side effects, such as swelling and fainting. The head of your bed may also be slightly raised. Do not get out of bed until your caregiver says it is okay.

  • Medicines:

    • Aspirin: This helps thin the blood to keep blood clots from forming. This medicine makes it more likely for you to bleed or bruise.

    • Blood pressure medicine: This may be given to lower your blood pressure. Keeping your blood pressure under control will protect your surgery site from breaking open.

    • Cholesterol medicine: This type of medicine is given to help decrease (lower) the amount of cholesterol (fat) in your blood.

  • Monitoring:

    • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

    • Neurologic signs: Your eyes, memory, grasp, and balance may be checked. This is done to monitor your brain before, during, or after surgery.

    • Ultrasound: An ultrasound uses sound waves to show pictures on a monitor. An ultrasound may be done to looks for clots in your carotid artery.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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