PERIPHERAL ENDARTERECTOMY 2
Category: Cardiovascular Surgery
Abstract : peripheral endarterectomy: A complete patient history is essential to diagnosis, particularly information about family members who may have had diabetes or early cardiovascular disease. Symptoms will be important diagnostic indicators, letting the physician know what areas of the body may have reduced blood flow. Blood pressure will be taken in the arms and legs. Pulses will be measured in the arm
peripheral endarterectomy: A complete patient history is essential to diagnosis, particularly information about family members who may have had diabetes or early cardiovascular disease. Symptoms will be important diagnostic indicators, letting the physician know what areas of the body may have reduced blood flow. Blood pressure will be taken in the arms and legs.
Pulses will be measured in the arms, armpits, wrists, groin, ankles, and behind the knees. This will show where blockages may exist, since the pulse below a blockage is usually absent. Additionally, a stethoscope will be used to listen for abnormal sounds in the arteries that may indicate narrowing.
Blood flow procedures may be performed, including:
• Doppler ultrasonography - direct measurement of blood flow and rates of flow, sometimes performed in conjunction with stress testing (exercise between tests).
• Angiography—an x ray procedure that provides clear images of the affected arteries before surgery is performed.
• Blood tests—routine tests such as cholesterol and glucose, as well as tests to help identify other causes of narrowed arteries, such as inflammation, thoracic outlet syndrome, high homocycteine levels, or arteritis.
• Spiral computed tomography (CT angiography) or magnetic resonance angiography (MRI)—less invasive forms of angiography.
If ultrasonography or angiography procedures were not performed earlier to diagnose arterial blockage, these tests will be performed before surgery to evaluate the amount of plaque and the extent and exact location of narrowing. Aspirin therapy or other clot-prevention medication may be prescribed before surgery. Any underlying medical condition, such as high blood pressure, heart disease, or diabetes will be treated prior to peripheral endarterectomy to help get the best result from the surgery. Upon admission to the hospital, routine blood and urine tests will be performed.
After the peripheral endarterectomy, the patient’s blood pressure, temperature, and heart rate will be monialtertored in a hospital recovery room for an hour or more, and the surgical site will be checked regularly. The patient will then be transferred to a concentrated care unit to be observed for any sign of complications. The total hospital stay may be two to three days. When the patient returns home, activities can be resumed gradually. Walking and strenuous activity may be restricted, especially if surgery was performed on the groin or leg. During recuperation, the patient may be given pain medication as needed and clot-prevention (anticoagulant) medication.
Patients will be advised to reduce the risk factors for artherosclerosis in order to avoid repeat narrowing or blockage of the arteries. Repeat stenosis (restenosis) has been shown to occur frequently in people who do not make the necessary changes in lifestyle, such as changes in diet, exercise, and quitting smoking. The benefits of the surgery may only be temporary if underlying disease, such as artherosclerosis, high blood pressure, or diabetes, is not also treated.
The risks associated with peripheral endarterectomy primarily involve the underlying conditions that led to blockage of arteries in the first place. Embolism is the most serious post-operative risk; a clot or piece of tissue from the endarterectomy site that may travel to the heart, brain, or lungs can cause heart attack, stroke, or death. Restenosis, the continuing build-up of plaque, can occur within months to years after surgery if risk factors are not controlled.
Other complications may include:
• reactions to anesthesia
• breathing difficulties
• changes in blood pressure
• nerve injury
• post-operative bleeding
Normal results
The outcomes of peripheral endarterectomy as a treatment for arterial blockage are usually good. Blood flow can be restored quickly to relieve symptoms and help prevent heart attack, stroke, organ failure, or limb amputation.
Morbidity and mortality rates
Morbidity and mortality depend upon the artery involved, the extent of the blockage, and the patient’s overall condition, which directly influences response to the surgery. Time is also a factor. In cases of sudden and complete blockage of the mesenteric arteries, for example, only immediate surgery can save the person’s life.
Although death does not frequently occur during peripheral endarterectomy surgery, patients with widespread atherosclerosis and PAD have been shown to have increased morbidity and mortality associated with coronary artery disease, because of the common risk factors, such as cigarette smoking, high blood pressure, and diabetes. PAD patients with diabetes are shown to represent 50% of all amputations. However, only a small percentage of patients undergoing peripheral endarterectomy will suffer limb loss or associated disability and reduced quality of life.
Alternatives
Peripheral endarterectomy removes plaque directly from blocked arteries; there is no alternative way to mechanically remove plaque. However, there are alternative ways to prevent plaque build-up and reduce the risk of narrowing or blocking the peripheral arteries. Certain vitamin deficiencies in older people, for example, are known to promote high levels of homocysteine, an amino acid that contributes to atherosclerosis and a higher risk for PAD.
Some nutritional supplements and alter native therapies that are recommended to help promote good vascular health include:
• Folic acid can help lower homocysteine levels and increase the oxygen-carrying capacity of red blood cells.
• Vitamins B6 and B12 can lower homocycteine levels.
• Antioxidant vitamins C and E work together to promote healthy blood vessels and improve circulation.
• Angelica, an herb that contains coumadin, a recognized anticoagulant, may help prevent clot formation in the blood.
• Essential fatty acids, as found in flax seed and other oils, can help reduce blood pressure and cholesterol, and maintain elasticity of blood vessels.
• Chelation therapy may be used to break up plaque and improve circulation.
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