Endarterectomy: the beginning of modern vascular surgery

Article Abstract:

Progress in vascular surgery, as in other fields of learning, advances through the integration of various anecdotally discovered experiences occurring in many different disciplines. Modern vascular surgery developed through knowledge contributed from the fields of surgery, medicine, radiology, microbiology and pharmacology. The first definitive and reliable operation to restore arterial circulation was endarterectomy, a procedure which removes the cholesterol plaque-thickened inner lining of the artery. This procedure was discovered by accident in 1946 when a surgeon removed a clot from the femoral (thigh) artery and inadvertently removed long fragments of the wall of the artery, which included the inner and middle layers of the wall. The obvious success of this procedure to restore blood flow in an occluded artery ran contrary to the medical concepts of the day. This discovery stimulated the rapid growth of modern vascular surgery. The progressive development of this procedure as it is performed today is discussed. Three basic skills are required to perform vascular surgery: endarterectomy, vascular bypass graft, and vascular graft replacement. Experience and judgment are required of the surgeon who performs these procedures because each patient presents a unique challenge. Innovation, imagination and modification of standard techniques of arterial reconstruction are often required. Resolution of one area of controversy often reveals yet another problem to be solved. The future challenges in vascular surgery include resolution of the carotid controversy (is surgery indicated when the patient is without symptoms?), the physiology of platelets (clotting factors), fibro-intimal hyperplasia (excessive growth of fibrous tissue in the lining of the artery), endothelial seeding, and continuing search for a better vascular graft. (Consumer Summary produced by Reliance Medical Information, Inc.)

History, Speeches, lectures and essays, Blood vessels, Vascular surgery, transcript

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Salvage after postoperative thrombosis of the carotid artery

Article Abstract:

Occurrence of a massive stroke is a serious potential complication following surgery to the carotid artery (one of the main vessels carrying blood to the brain and head). One cause of stroke associated with these cases results from the formation of a blood clot in the internal carotid artery. Dense hemiparesis (extensive muscle weakness) may appear after endarterectomy, surgery to clear the artery of obstruction. This can be treated by early surgical intervention to restore blood flow. A report is provided of one hospital's experience with carotid endarterectomy patients over a five-year period. Out of 302 patients who underwent surgery, dense hemiparesis appeared during the immediate postoperative period in four patients who had carotid endarterectomy and in one patient who had a carotid subclavian bypass (a graft to allow blood to flow between the subclavian and carotid arteries, bypassing the affected area of the carotid). The patients' symptoms began between 30 minutes and 10.5 hours after surgery, and they were returned to the operating room as quickly as possible. All of the subjects developed thrombosis (blood clot) of the carotid artery. The clots were removed and venous patches or grafts were applied. All five patients survived and were discharged from the hospital. One of the patients had no residual neurological deficits, three had mild deficits, and one was severely impaired. The relative merits of immediate repair versus waiting for more accurate diagnosis of the cause of the hemiparesis using more time-consuming tests are discussed. On balance, early reoperation is recommended using procedures that reduce the risk of occlusion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Prevention, Causes of, Complications and side effects, Stroke (Disease), Stroke, Thrombosis, Carotid artery, Carotid arteries

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