Endarterectomy

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Endarterectomy
Carotid Endarterectomy svg hariadhi.svg
Endarterectomy- plaque removal by surgical excision and closure
ICD-9-CM 38.1
MeSH D004691

Endarterectomy is a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of deposits. It is carried out by separating the plaque from the arterial wall.

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It was first performed on a subsartorial artery in 1946 by a Portuguese surgeon, João Cid dos Santos, at the University of Lisbon. In 1951, E. J. Wylie, an American, performed it on the abdominal aorta. The first successful reconstruction of the carotid artery was performed by Carrea, Molins, and Murphy in Argentina, later in the same year. [1]

Atherosclerotic plaque from a carotid endarterectomy specimen Carotid Plaque.jpg
Atherosclerotic plaque from a carotid endarterectomy specimen

An endarterectomy of the carotid artery in the neck is recommended to reduce the risk of stroke when the carotid artery is severely narrowed, particularly after a stroke to reduce the risk of additional strokes.[ citation needed ]

Coronary endarterectomy involves removing atheroma from the wall of blocked blood vessels (coronary) supplying the heart muscle. The concept was first introduced by Bailey [2] in the 1950s prior to the advent of coronary artery bypass surgery to help patients with angina and coronary artery disease. It is still used today when coronary artery bypass surgery proves difficult. Livesay [3] in Texas and Nair [4] in Leeds have published the largest series in the world.

A femoral endarterectomy is also frequently used as a supplement to a vein bypass graft at the sites of surgical anastomosis. Pulmonary hypertension caused by chronic thromboembolic disease (CTEPH) may be amenable to pulmonary thromboendarterectomy of the pulmonary artery. This procedure was refined by Jamieson over the last two decades and his technique has become the standard worldwide. [5]

See also

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<span class="mw-page-title-main">Carotid endarterectomy</span> Surgical procedure

Carotid endarterectomy is a surgical procedure used to reduce the risk of stroke from carotid artery stenosis. In endarterectomy, the surgeon opens the artery and removes the plaque. The plaque forms and thickens the inner layer of the artery, or intima, hence the name of the procedure which simply means removal of part of the internal layers of the artery.

<span class="mw-page-title-main">Carotid artery stenosis</span> Medical condition

Carotid artery stenosis is a narrowing or constriction of any part of the carotid arteries, usually caused by atherosclerosis.

<span class="mw-page-title-main">Watershed stroke</span> Medical condition

A watershed stroke is defined as a brain ischemia that is localized to the vulnerable border zones between the tissues supplied by the anterior, posterior and middle cerebral arteries. The actual blood stream blockage/restriction site can be located far away from the infarcts. Watershed locations are those border-zone regions in the brain supplied by the major cerebral arteries where blood supply is decreased. Watershed strokes are a concern because they comprise approximately 10% of all ischemic stroke cases. The watershed zones themselves are particularly susceptible to infarction from global ischemia as the distal nature of the vasculature predisposes these areas to be most sensitive to profound hypoperfusion.

<span class="mw-page-title-main">Pulmonary thromboendarterectomy</span>

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<span class="mw-page-title-main">Hollenhorst plaque</span> Medical condition

A Hollenhorst plaque is a cholesterol embolus that is seen in a blood vessel of the retina. It is usually found when a physician performs ophthalmoscopy, during which a plaque will appear as a small, bright crystal that is refractile and yellow. This is a medical exam finding, and is not a medical condition, though it may be related to cardiovascular conditions such as atherosclerosis of the internal carotid artery. It was first described by American ophthalmologist Robert Hollenhorst in 1961.

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Carotid artery stenting is an endovascular procedure where a stent is deployed within the lumen of the carotid artery to treat narrowing of the carotid artery and decrease the risk of stroke. It is used to treat narrowing of the carotid artery in high-risk patients, when carotid endarterectomy is considered too risky.

<span class="mw-page-title-main">Hybrid cardiac surgery</span>

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term disease caused by a blockage in the blood vessels that deliver blood from the heart to the lungs. These blockages cause increased resistance to flow in the pulmonary arterial tree which in turn leads to rise in pressure in these arteries. The blockages either result from organised blood clots that usually originate from the deep veins of the lower limbs of the body (thromboembolism) and lodge in the pulmonary arterial tree after passing through the right side of the heart. The blockages may also result from scar tissue that forms at the site where the clot has damaged the endothelial lining of the pulmonary arteries, causing permanent fibrous obstruction. Most patients have a combination of microvascular and macrovascular obstruction. Some patients may present with normal or near-normal pulmonary pressures at rest despite symptomatic disease. These patients are labelled as having chronic thromboembolic disease (CTED).

<span class="mw-page-title-main">Stuart W. Jamieson</span> British surgeon

Stuart William Jamieson is a British cardiothoracic surgeon, specialising in pulmonary thromboendarterectomy (PTE), a surgical procedure performed to remove organized clotted blood (thrombus) from pulmonary arteries in people with chronic thromboembolic pulmonary hypertension (CTEPH).

The Yasui procedure is a pediatric heart operation used to bypass the left ventricular outflow tract (LVOT) that combines the aortic repair of the Norwood procedure and a shunt similar to that used in the Rastelli procedure in a single operation. It is used to repair defects that result in the physiology of hypoplastic left heart syndrome even though both ventricles are functioning normally. These defects are common in DiGeorge syndrome and include interrupted aortic arch and LVOT obstruction (IAA/LVOTO); aortic atresia-severe stenosis with ventricular septal defect (AA/VSD); and aortic atresia with interrupted aortic arch and aortopulmonary window. This procedure allows the surgeon to keep the left ventricle connected to the systemic circulation while using the pulmonary valve as its outflow valve, by connecting them through the ventricular septal defect. The Yasui procedure includes a modified Damus–Kaye–Stansel procedure to connect the aortic and pulmonary roots, allowing the coronary arteries to remain perfused. It was first described in 1987.

<span class="mw-page-title-main">Arterial occlusion</span>

Arterial occlusion is a condition involving partial or complete blockage of blood flow through an artery. Arteries are blood vessels that carry oxygenated blood to body tissues. An occlusion of arteries disrupts oxygen and blood supply to tissues, leading to ischemia. Depending on the extent of ischemia, symptoms of arterial occlusion range from simple soreness and pain that can be relieved with rest, to a lack of sensation or paralysis that could require amputation.

References

  1. Thompson, Jesse E. (August 1996). "The Evolution of Surgery for the Treatment and Prevention of Stroke: The Willis Lecture". Stroke. 27 (8): 1427–1434. doi:10.1161/01.str.27.8.1427. PMID   8711815.
  2. Bailey, Charles P.; MAY A; LEMMON WM (1957). "Survival After Coronary Endarterectomy in Man". Journal of the American Medical Association. 164 (6): 641–646. doi:10.1001/jama.1957.02980060017005. PMID   13428537.
  3. Livesay, James J.; Cooley, Denton A.; Hallman, Grady L.; Reul, George J.; Ott, David A.; Duncan, J. Michael; Frazier, O. Howard (October 1986). "Early and late results of coronary endarterectomy". The Journal of Thoracic and Cardiovascular Surgery. 92 (4): 649–660. doi: 10.1016/S0022-5223(19)35867-2 .
  4. Ariyaratnam, Priyadharshanan; Javangula, Kalyana; Papaspyros, Sotiris; McCrum-Gardner, Evie; Nair, Ramanpillai Unnikrishanan (1 December 2012). "Long-term survival from 801 adjunctive coronary endarterectomies in diffuse coronary artery disease". European Journal of Cardio-Thoracic Surgery. 42 (6): e140–e145. doi: 10.1093/ejcts/ezs510 . PMID   23014969.
  5. Jamieson, Stuart (2011-10-15). "Bypass, circulatory arrest, and pulmonary endarterectomy". The Lancet. 378 (9800): 1359–1360. doi:10.1016/S0140-6736(11)61384-6. ISSN   0140-6736. PMID   22000123. S2CID   12353955.