Endarterectomy Surgery

Endarterectomy is surgery to remove plaque buildup in your carotid or peripheral arteries to restore blood flow to your brain or leg. It lowers the risk of stroke or complications of peripheral arterial disease (PAD).

UPMC vascular surgeons use the latest minimally invasive techniques to provide expert care for blockages in blood vessels in the neck, leg, arms, and belly.

---

---

What Is Endarterectomy Surgery?

Endarterectomy is surgery to remove plaque buildup in your arteries and restore blood flow to your brain, leg, arm, or belly. It lowers the risk of stroke or complications of peripheral arterial disease (PAD).

Types of endarterectomy surgery

There are a few types of endarterectomies based on where you have a blockage:

• Femoral endarterectomy removes blockages from blood vessels in your leg.
• Carotid endarterectomy removes plaque from arteries in your neck.
• Peripheral vascular endarterectomy removes plaque from veins either in your legs, arms, or belly.

Your surgeon may perform a minimally invasive endarterectomy or a traditional open endarterectomy.

Minimally invasive endarterectomy

During a minimally invasive endarterectomy, your vascular surgeon will thread a balloon catheter through a small incision in your groin or wrist and guide it to the site of the blockage. After the catheter is in place, your doctor will inflate the balloon to open your artery and improve blood flow. If necessary, your doctor will use a special device to prevent plaque from moving through your arteries and blocking blood vessels in your brain.

Traditional open endarterectomy

In a traditional procedure, you will receive a sedative medication in your IV before the procedure to help you relax. Your surgeon will make an incision near the site of your blockage to reach the artery and remove the plaque. The artery is then repaired, and the incision is closed.

Where is the incision for a carotid endarterectomy?

Incisions for carotid endarterectomy procedures are typically made in the neck. However, if your surgeon performs a minimally invasive procedure using a catheter, your incision may be in your groin or wrist.

Conditions we treat with endarterectomy surgery

• Aortoiliac disease.
• Carotid artery disease.
• Peripheral artery disease (PAD).
• Peripheral vascular disease.

Why Would I Need Endarterectomy Surgery?

Smoking, high blood pressure, high cholesterol, and a family history of cardiac conditions can increase your risk of developing plaque in your arteries.

Plaque in your arteries can cause the inside to become narrow, leading to blockages and damage. When the inside lining of your arteries becomes narrow due to damage, it can affect blood flow in your:

• Arm.
• Belly.
• Leg.
• Neck.

If you have blockages in your arteries, your doctor may recommend an endarterectomy to restore blood flow.

Is endarterectomy major surgery?

Although endarterectomy is usually performed through a small incision, it is a complex procedure that can reduce the risk of a life-threatening stroke and other serious complications.

Who’s a candidate for endarterectomy surgery?

You may be a candidate for endarterectomy surgery if:

• You are at risk of a stroke due to blockage in your carotid artery.
• You have had a stroke or transient ischemic attack (TIA).
• You have plaque buildup in the arteries in your arms or legs.
• You have plaque buildup in the main arteries in your abdomen or pelvis.

Alternatives to endarterectomy surgery

• Peripheral artery angioplasty and stenting, during which a catheter with a balloon opens blocked arteries and a stent is inserted into the artery to keep it open and improve blood flow. 
• Carotid artery angioplasty and stenting, during which a catheter with a balloon opens the carotid artery, and a stent is inserted into the artery to keep it open and improve blood flow. which includes
• Transcarotid artery revascularization (TCAR), during which your surgeon will reverse the blood flow through your carotid artery when clearing the blockage

What Are the Risks and Complications of Endarterectomy Surgery?

As with any surgery, endarterectomy has risks. Many of the risks relate to your age, current health status, and the severity of your blockage.

Complications may include:

• Blood clots.
• Internal bleeding or bruising.
• Nerve damage.
• Stroke.

Your doctor will work with you to decide if endarterectomy is right for you.

What Should I Expect From Endarterectomy Surgery?

During your first visit, your doctor will go over your medical history and perform a physical exam.

You may also have a series of tests, including:

• Ultrasound — A test that produces images using sound waves and determines the extent of the narrowed artery and the blood flow to the brain.
• Magnetic resonance angiography (MRA) — MRA provides detailed imaging through radiofrequency waves in a magnetic field.
• CT angiography — A test that uses special CT imaging to accurately find blockages in the arteries.

Before: How to prepare for endarterectomy surgery

Your doctor will explain the endarterectomy procedure to you and give you a chance to ask questions. To prepare for the procedure, you should:

• Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
• Tell your doctor if you have heart valve disease, as you may need to receive an antibiotic before the procedure. 
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of the medications prior to the procedure.
• Fast for a certain period of time prior to the procedure. Your doctor will tell you how long to fast (usually overnight).
• Have any tests that your doctor recommends. For example, your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.

On the day of your procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home.

You will need to stay in the hospital for several days after your procedure. You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You should also arrange for someone to drive you home from the hospital after you are discharged.

How long does endarterectomy surgery take?

Endarterectomy surgery can take a few hours based on the location and severity of the blockage.

During your endarterectomy surgery

You'll receive general anesthesia, so you won't be awake during surgery.

During a traditional open endarterectomy, your surgeon will:

• Make a small cut in your blocked blood vessel.
• Remove the plaque and any other buildup inside the artery to restore healthy blood flow.
• Stitch up the cut.

During a minimally invasive endarterectomy, your surgeon will:

• Insert a catheter into your blood vessel through a small incision.
• Guide the catheter to the site of the blockage using x-ray imaging guidance.
• Use the catheter to remove the blockage. If needed, your doctor may place a stent to hold the blood vessel open after the blockage is removed.
• Remove the catheter and close the incision.

Recovery after endarterectomy surgery

After your endarterectomy, you'll spend a few nights in the hospital. Your care team will keep a close eye on you to make sure you don't have any complications from the surgery.

You will be sore around the surgery site.

Your doctor will prescribe medications to ease the pain and prevent infection. He or she will also tell you how to best care for your incision and prevent future plaque buildup in your arteries.

How long does it take to fully recover after endarterectomy?

You should be able to return to your normal routine 3-4 weeks after your endarterectomy surgery.

When to call your doctor about endarterectomy surgery complications

You should call your doctor if you are experiencing any unusual symptoms, including:

• Pain, redness, bleeding, drainage, or increased swelling at the incision site.
• Trouble walking or speaking.
• Numbness on one side of your body.
• Severe pain, coldness, numbness, or discoloration in the limb where the catheter was inserted.
• A fever of more than 100.0°F.

If any of these symptoms are severe, you should dial 911 immediately.

What’s the prognosis after endarterectomy surgery?

For most patients, endarterectomy surgery restores blood flow, improves symptoms, and helps reduce stroke risk.

What is the life expectancy after carotid endarterectomy?

With lifestyle changes, medication, and follow-up care, most patients are able to manage their stroke risk and live active, fulfilling lives. If you have questions about your life expectancy after your carotid endarterectomy, talk to your doctor.

What’s the success rate of endarterectomy surgery?

The success rate of your endarterectomy depends on your age, your overall health, and the severity of the blockage. Your doctor will discuss the expected success rate of the procedure with you.

Why Choose UPMC for Endarterectomy Surgery?

When you choose UPMC for your endarterectomy, you will receive expert care from some of the region's most experienced vascular surgeons. We provide expert care using either minimally invasive or traditional open techniques, depending on your specific condition. If endarterectomy isn’t the best option for you, we'll recommend other treatments that better suit your needs.

---

By UPMC Editorial Staff. Last reviewed on 2024-10-01.