Endarterectomy By Natalie Younce Ribka Panjaitan Cristal Partida

Endarterectomy By: Natalie Younce, Ribka Panjaitan, Cristal Partida, Heidi Reiterman, Megan Rockey

Procedure An endarterectomy is a procedure used to unblock arteries by removing the plaque or build up and by widening the artery to prevent further damage. An example of one of these procedures is a carotid endarterectomy. In a carotid endarterectomy you receive a local or general anesthetic. Your surgeon makes an incision along the front of your neck, opens your carotid artery and removes the plaques that are clogging your artery. Your surgeon then repairs the artery with stitches or a patch made with a vein or artificial material (patch graft). Doctors may recommend carotid endarterectomy if you have more than 60 percent blockage in your arteries. You may or may not be experiencing symptoms. Your doctor will evaluate your condition and determine whether you're a candidate for carotid endarterectomy. https: //www. youtube. com/watch? v=f. Gw 0 o. Bmmu. HM Natalie

What test are needed? Arteriogram Ankle-Brachial Index (ABI) Test to compare the blood pressure in your ankle and your arm. This test shows how well blood is flowing in your limbs. Doppler Ultrasound Angiography Ultrasound may be used to determine which arteries are blocked. 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 An arteriogram provides a "road map" of the arteries. Doctors use this test to find the exact location of a blocked artery. Magnetic Resonance Angiogram An MRA can show the location and severity of a blocked blood vessel.

Preparation Preoperative Assessment Detailed history: Medical history, surgical history, tolerance of anesthesia, medication use, substances use, cultural considerations Allergies: Medications, latex, contrast agents, food products Anxiety level: regarding the procedure, support system, and coping mechanisms Baseline data: Head-to-toe assessment, vital signs, and oxygen saturations Emotional ● Educate the patient on what to expect after the surgery ● Answer any questions patient may have Spiritual ● Consultation with chaplain at patient’s request ● Allow the patient to have time to complete any spiritual routines they may need before surgery Ethical ● Advocate for patient’s wishes ● Follow hospital protocols when caring for patients Informed Consent 1. Ensure client understands and acknowledges the information about the procedure 2. Determine if client is capable of giving informed consent 3. Witness the client signing

Preparation cont. ● Depending on surgical procedure, patient may have one or more IV lines, urinary catheter, central venous catheter, and/or arterial line. ● To prevent postoperative infection, antibiotic therapy is typically given before the procedure. ● NPO from midnight the day before surgery. ● Supine position with head turned away from the side. ● Anesthesia is given under general, epidural, or spinal. Post-op ● Thorough and ongoing nursing assessment for postoperative arterial revascularization to detect complications. ● Deep breathing every 1 to 2 hours, using incentive spirometer to prevent respiratory complications.

Possible Complications of doing the procedure: ● Embolism---> Stroke---> Death Embolic protection device ● ● Nerve damage: affecting voice box, tongue or back Pain or numbness at wound site (temporary) Bleeding/ blood clots/ infection Restenosis (narrowing of the carotid again) Possible Complications of NOT doing the procedure: ● ● ● Untreated Plaque buildup could cause: Embolism TIA Stroke MI DEATH!

Patient Education ● Educate patient on what to expect after the procedure such as: ○ A sore throat, hoarse voice ○ Upon returning to a normal diet patient should consume soft foods such as soups or yogurt. ● Educate pt on S/S of a stroke ● Educate pt on S/S of infection ● Educate pt on modifiable lifestyle changes to reduce the risk factors that contribute to plaque buildup: ○ Smoking- Encourage smoking cessation ○ Unhealthy diet - Encourage patient to avoid foods that are high in saturated and trans fats, cholesterol, sodium and sugar. ○ Sedentary lifestyle- Encourage exercise Other risk factors include other health conditions such as; diabetes, hypertension, heart disease

Immediate and Long-Term Post-Procedure Care Patient’s blood pressure, temperature and heart rate will be monitored in a recovery room for an hour or more post surgery as well as surgical site checking regularly. Then will be transferred to a concentrated care unit, like post op unit, to be observed for any complications. Total hospital stay may be 2 -3 days. Return home→ activities can resume gradually. Put on pain medications and clot-preventions (anticoagulants). If surgery done in groin/upper thigh area, long walking and other strenuous activity is not recommended. Educate patient on changes in diet, exercise and smoking cessation to prevent repeating of the narrowing/blockages in the arteries. Recurrence may occur/surgery may not be permanently effective if underlying conditions such as (atherosclerosis, high blood pressure or diabetes) is not also treated.

References Mayo Clinic Staff. (2014, December 18). Tests and Procedures Carotid endarterectomy. Retrieved from Mayo. Clinic. org: https: //www. mayoclinic. org/tests-procedures/carotid-endarterectomy/basics/definition/PRC-20020532 How Is Carotid Artery Disease Diagnosed? (2016, June 22). Retrieved December 05, 2017, from https: //www. nhlbi. nih. gov/health-topics/catd/diagnosis National Institutes of Health. (2016, June 22). How Is Peripheral Artery Disease Diagnosed? Retrieved December 06, 2017, from https: //www. nhlbi. nih. gov/health-topics/pad/diagnosis Carotid Endarterectomy and Stenosis. (n. d. ). Retrieved December 06, 2017, from http: //www. aans. org/Patients/Neurosurgical. Conditions-and-Treatments/Carotid-Endarterectomy-and-Stenosis Risk of carotid endarterectomy in the elderly. (n. d. ). Retrieved December 06, 2017, from http: //ajph. aphapublications. org/doi/abs/10. 2105/AJPH. 79. 12. 1617 Carotid Endarterectomy https: //vascular. org/patient-resources/vascular-treatments/carotid-endarterectomy#risks