An endarterectomy is a type of vascular surgery. Surgeons use endarterectomies to remove a fatty substance called plaque from inside a person’s artery.

Plaque consists of fat, cholesterol, red blood cells, and other substances. It can build up on the walls inside a person’s arteries. Over time, deposits of plaque can cause the arteries to become narrowed or blocked. This is known as atherosclerosis.

Without treatment, plaque buildup may lead to a person developing complications, such as stroke or heart attack. Endarterectomies allow a surgeon to remove the plaque from inside an artery.

Read on to learn more about endarterectomies, including the different types and what to expect during surgery.

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Endarterectomies can help treat people with atherosclerosis. This condition can reduce the amount of oxygen-rich blood that reaches different parts of a person’s body.

For example, if someone has atherosclerosis in the artery in their neck, which is the carotid artery, it can reduce the amount of oxygen their brain receives. Information from the American Association of Neurological Surgeons notes that carotid artery endarterectomies can help reduce a person’s risk of having a stroke.

The National Heart, Lung, and Blood Institute notes that atherosclerosis can affect most of the arteries in a person’s body, including those in the:

  • brain
  • heart
  • kidneys
  • pelvis
  • arms
  • legs

Health experts may refer to atherosclerosis with different names depending on the artery it affects. For example, they call it carotid artery disease when it affects the carotid arteries in the neck.

A surgeon may use an endarterectomy to treat a person with plaque buildup that blocks 50% or more of their artery. Someone with a blockage of 50–79% may require an endarterectomy if they have had a stroke or mini-stroke.

Generally, surgeons will consider endarterectomies to treat people with carotid artery disease. However, they can also treat atherosclerosis in other areas of the body.

The type of endarterectomy an individual has depends on what artery atherosclerosis is affecting. Different forms of endarterectomy include:

  • carotid endarterectomy
  • aortic endarterectomy, which involves the aorta, which carries blood from the heart to the rest of the body
  • femoral endarterectomy, which involves the femoral artery in a person’s thigh
  • iliac endarterectomy, which involves the iliac arteries, which supply blood to the pelvis and legs
  • renal endarterectomy, which involves the renal arteries that supply the kidneys with blood

An endarterectomy surgery generally takes 1–2 hours. Surgeons usually perform the surgery in the operating room of a hospital.

An endarterectomy may involve the following steps:

  1. A nurse inserts an intravenous (IV) line into a person’s arm. This provides the patient with fluids and medications during the procedure.
  2. An anesthesiologist uses local anesthetic to numb the area where the surgery will occur. A person may also receive general anesthetic depending on the type of surgery they are having. General anesthetic causes someone to fall asleep for the duration of the surgery.
  3. If an anesthesiologist uses general anesthetic on a person, a doctor may insert a breathing tube in the patient’s lungs. The doctor then attaches the breathing tube to a ventilator. This helps the patient breathe during surgery.
  4. The surgeon makes a cut in the person’s skin over the area where the blocked artery is. The surgeon then cuts into the artery and removes the plaque.
  5. The surgeon may insert a stent inside the artery to help prevent it from becoming blocked again.
  6. The surgeon removes the shunt and closes up the person’s artery using vein tissue from another part of the body, synthetic tissue, or cow tissue.
  7. The surgeon then closes the incision in the patient’s skin and covers it with a sterile dressing.

A person’s doctor will discuss what an endarterectomy will involve before they have the procedure. They will also explain how the patient should prepare for surgery and provide information on the recovery time and possible risks.

Before someone has an endarterectomy, they need to let their doctor know if they:

  • are taking any medications, herbal products, or dietary supplements
  • are diabetic and need to adjust their medication on the day of surgery
  • have any allergies to medications, latex, iodine, tape, or anesthetics
  • have a history of bleeding disorders
  • have any implanted devices, such as a pacemaker
  • have any piercings on their chest or abdomen
  • are pregnant

A person needs to be careful not to eat after midnight the day before they have surgery.

In general, a person should be able to go home 1–2 days after an endarterectomy. However, the hospital stay can be longer if the procedure takes place in a harder to reach area, such as the abdomen. During this time, healthcare professionals will monitor the individual.

A person may have pain or bruising around the site of their endarterectomy. A doctor may prescribe pain medication to help patients control their pain during recovery. They may also prescribe medication to help prevent blood clots.

A doctor may recommend avoiding strenuous exercise or heavy lifting for a few weeks after surgery. Healthcare professionals can speak with someone about when they can return to work if it is applicable.

The effectiveness of an endarterectomy may depend on the type of atherosclerosis a person has.

A 2022 article commenting on older research notes that carotid endarterectomies can help significantly decrease the risk of stroke in people with moderate to severe carotid artery disease.

A 2018 study found that common femoral artery endarterectomies were very effective at keeping the femoral artery clear and unblocked. They also provided improvement to blockages in the femoral artery.

A 2019 retrospective analysis states that remote iliac artery endarterectomies are effective procedures for keeping an artery open and clear. However, someone is more likely to have additional narrowing of their artery if doctors do not insert a stent during the procedure. Additionally, it is worth noting that remote iliac artery endarterectomy is a relatively uncommon procedure.

A doctor will speak with a person about the possible risks of an endarterectomy before they have surgery. There may be different risks depending on the type of procedure a person has.

Possible risks of endarterectomies may include:

  • bleeding
  • infection
  • re-narrowing of the artery
  • heart attack
  • stroke
  • death
  • nerve injury
  • swelling

Endarterectomies are a form of vascular surgery. Surgeons use them to remove plaque buildup from inside a person’s arteries. This can help prevent potential complications, such as a stroke. There are different types of endarterectomy, and the type of technique a person has will depend on the affected artery.