Intimectomy

Intimectomy

Intimectomy

Removing the inner wall of the artery that is affected by atherosclerotic plaques

VASCULAR SURGERY – EURODOCTOR.RU – 2007

Endarterectomy – the general term for surgical removal of the inner wall of the artery that is affected by atherosclerotic plaques. Normally, the inner wall of the arteries smooth and flat. However, the development of atherosclerosis in the arterial wall are formed tumors consisting of cholesterol, calcium and fibrous tissue. Eventually, the artery narrows and the normal blood flow is completely stopped.
For the treatment of narrowing of the arteries used different techniques such as angioplasty, stenting and endarterectomy.
The technique of endarterectomy is that the surgeon carries out an incision in the artery of the affected area and scrape the inside of the wall, on which there is atherosclerotic plaque. After this operation, the artery widens considerably, thereby recovering the bloodstream. While some treatment is less invasive, in some cases, endarterectomy is more effective, safer and cheaper. Sometimes endarterectomy combined with methods such as bypass surgery or expansion.
Most often used for endarterectomy restoring blood flow in the carotid arteries. It is used in the treatment of obliterating atherosclerosis of lower extremities, stenosis of the renal artery occlusive diseases of the aorta and iliac vessels, chronic ischemia mesaraic.

Preparing for endarterectomy

To reduce the risk of blood clots, your doctor may recommend medications that reduce blood clotting, such as aspirin or klopidrogel (Plavix) for several days. Usually, before the operation is necessary to clarify the localization of atherosclerotic plaques. To this end, the patient is taking a number of studies.
The very first method in this series is duplex ultrasound scanning. This method allows the study to assess blood flow velocity in the carotid arteries, the presence of narrowing of their lumen in the form of plaques, blood clots.
Magnetic resonance angiography – a method that allows you to see the flow of blood in the vessels and their narrowing. It uses radio waves in conjunction with the magnetic field.
Angiography – This method consists in the fact that the artery injected contrast material and conducted a series of images. The method allows to detect narrowing of the arteries, the presence of plaques on their walls.
Usually the patient before surgery prohibits eating for 8 hours. If you are taking any medication, you must tell your doctor.

Are you suitable for endarterectomy?

In these cases, surgery is contraindicated endarterectomy:

  • malignant tumors
  • high blood pressure
  • diabetes mellitus
  • angina
  • myocardial infarction within the last 6 months
  • congestive heart failure
  • signs of progressive brain disease, such as Alzheimer's disease

What is the risk of complications during surgery?

Risk factors for complications during endarterectomy include:

  • advanced age
  • the presence of serious concomitant diseases such as cancer
  • blockage of lumen plaque
  • operation is carried out before endarterectomy
  • high blood pressure
  • diabetes mellitus
  • congestive heart failure
  • angina
  • problems with other vessels of the brain

Preference for choosing a particular method of operation is ultimately dependent on the current situation.

The procedure of endarterectomy

Features of this operation depends on the location of the affected artery. In a typical case of machinery is as follows. The surgeon holds the incision in the affected artery. It stands out. Next, the surgeon may enter a tube – a shunt – above and below the narrowing of the artery. Sometimes you simply put the clamp on the artery for a short period of time. After this, the artery is opened and a special tool to scrape the plaque or blood clots. Further, after the wall of the artery is cleared, it is restored. If the shunt has been imposed, it is removed. Thus, reduced blood flow in arteries. The wound sutured, and sterile dressing is applied.

The postoperative period after endarterectomy

Depending on where the surgery the patient after surgery may remain in hospital for a day. In the first 24 hours the patient needs a follow-up. 1 month after surgery, the patient must be examined by a surgeon. It is recommended to duplex ultrasound to assess the nature of blood flow. You should immediately seek medical attention in case of the following:

  • weakness
  • numbness
  • speech disorders
  • impairment
  • chest pain
  • fever, chills, discharge from the wound
  • increasing swelling and pain
  • shortness of breath

Necessary to control blood cholesterol, blood pressure, blood sugar readings in the case of treat accordingly.

Complications of endarterectomy

As with any surgery, possible complications after endarterectomy. The most serious of them – is a stroke. The risk of developing it is 1 – 3%. In addition to stroke, a complication occurs such as a re-blockage of the artery, called restenosis. It is most common in those patients who did not give up smoking. The risk of restenosis is 2-3%. Another complication is nerve damage that leads to the frustration of voice (hoarseness), difficulty swallowing, numbness of the face or tongue. Typically, these complications do not require special treatment and resolved on their own in a month.

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