Carotid Endarterectomy Surgery
Carotid Endarterectomy is one of the most common operations performed by vascular surgeons. Its purpose is to prevent a stroke (see above) by removing atherosclerotic plaque from the carotid artery. It can not reverse the effects of a stroke that has already occurred. It can be performed under local anesthetic or general anaesthetic. There is no convincing evidence that either general or local anaesthetic is safer and the choice is usually your preference or your surgeon's. The surgery involves an incision in the neck over the course of the carotid artery. The artery is clamped (i.e. temporarily blocked by a surgical instrument) above and below the narrowing and then opened. Your surgeon may choose to use a small plastic tube (a "shunt") to maintain flow in the carotid artery while it is the clamped. Your surgeon will then carefully remove the diseased plaque from your carotid artery leaving behind a smooth surface. The opening in the artery is then usually closed with a patch. A variety of materials can be used for the patch (e.g. a spare segment of one or your own veins or Dacron - a polyester type material). The purpose of the patch is to widen the artery to minimize the chance of it re-narrowing in the future. The surgery usually takes about 2 hours. The neck incision is not usually very painful and most patients only need to stay in hospital 1 or 2 nights after their surgery. You may have small plastic tube coming out of your neck (a drain) for the first 24 hours after surgery. This is designed to try to detect and manage any bleeding that may occur after the surgery. If present it is usually removed the morning after the surgery. Your surgeon will probably want to see you 4 to 6 weeks after your surgery to check on you. They may wish to obtain an ultrasound scan to check on your carotid artery at this time but due to the low rate of complications after carotid surgery long term follow up is not justified.
Potential Complications of Carotid Surgery
All surgery carries the risk of complications. Although carotid endarterectomy is a major operation it is generally very well tolerated and the serious post-operative complications are uncommon. Some of the most serious and common complications are listed below. This list is not exhaustive and you should consult your surgeon regarding any specific concerns you may have.
- Stroke: This is the most feared complication of carotid surgery. The incidence of this changes with various factors but in general is in the range of 1- 4%. Half of these strokes result in permanent severe disability. It is important to realize that any risk of stroke associated with the surgery is less than the risk of not performing the surgery – hence the reason for operating.
- Bleeding: Any operation on an artery carries the risk of bleeding. Minor bruising is common and requires no specific treatment. Large bruises or active bleeding almost always require a second operation.
- Infection: This is relatively uncommon compared to operations in other parts of the body. In most cases a short course of antibiotics is all that is required. In very rare cases where the infection involves the patch a major second operation may be required.
- Nerve injury: Many important nerves run near the carotid artery. Damage to these nerves can result in disturbances of speech or facial movement. In most cases this damage is due to the nerves being stretched so is temporary and the symptoms recover with time. Occasionally (≈ 1%) the damage can be permanent.
- Numb patches: All patients end up with a small numb patch just in front of the incision as the skin incision inevitably divides tiny nerves that supply the skin to this area. With time (i.e. months to years) this numb patch generally recedes in size. Male patients often have to take extra care when shaving not to cut their skin because of this numb patch. Occasionally patients will end up with a numb or painful ear if the nerve supplying skin to this area is cut during surgery.
- Scarring: Most neck incisions heal with minimal scarring, however with any surgery there is the risk of unsightly scar formation.
- Heart Attack: These are uncommon after carotid surgery but can occur as people who have narrowings in their carotid arteries could also have narrowings in their heart arteries. If a heart attack does occur it would need to be managed by a cardiologist. Other medical complications can also occur after carotid surgery such as irregular heart beats, low or high blood pressure and chest infections. These are all usually managed effectively with additional medications.
- Re-narrowing: It is uncommon for the carotid artery to re-narrow after carotid surgery (<5%). Even if it does re-narrow it is uncommon for re-narrowing to cause further TIAs or strokes. For this reason prolonged follow up after carotid surgery is not usually required.
Discharge Information after Carotid Surgery
- Pain relief - after leaving hospital you should not require anything stronger than regular paracetamol for pain relief.
- You should not drive for four weeks after carotid surgery. After then you can drive as long as you can move your neck freely.
- You can resume regular exercise as soon as you feel comfortable to do so.
- You can wet you incision but be careful to pat it dry.
- It is not uncommon to experience neck stiffness after carotid surgery.
- If you have any concerns about your incision you should see your GP or contact your surgeon. You should see a doctor if you develop redness, swelling or discharge from your incision.
- If you experience severe headaches, visual disturbances or weakness/tingling down one side of your body you should seek medical attention immediately.
- It is very important you continue to take the medications your doctor has prescribed you. It is also very important that you stop smoking if you still do so.