Originator: Mr Pathak - Consultant Vascular Surgeon, Joy lewis - Vascular Clinical Nurse SpecialistDate: September 2011

Version: 1Date for Review: September 2014

DGOH Ref No: DGOH/PIL/00519

Carotid EndarterectomyVascular SurgeryPatient Information Leaflet

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What Is Carotid Endarterectomy?

Every day in Great Britain, many people have a stroke (CVA) orwarning signs of a stroke (mini stroke or TIA). Such patients are ata higher risk of having another, perhaps a major stroke.

All patients with an increased risk of stroke are given medicaltreatment and advice to reduce this risk. This includes treatment ofhigh blood pressure, diabetes, high fat levels, heart disease andstopping smoking. In addition, Aspirin or alternative drug isgenerally given.

However, in many cases, surgical treatment is also recommended.In these cases, such as yourself, there is a high degree ofnarrowing of the artery in your neck that supplies blood to the brain(carotid artery). This is due to hardening of the arteries(atherosclerosis). It is important to realise that the left side of thebrain looks after the right arm and leg and the right side of the brainlooks after the left arm and leg. For this reason, the patient oftenthinks that the "wrong" side is being operated upon when in fact itis the correct side.

At present, we also know that the presence of a narrowing(stenosis) in your carotid artery makes the chances of suffering astroke in the future much higher than in a person without such anarrowing. We also know that performing an operation calledcarotid endarterectomy (to correct the narrowing) will actuallyreduce the chances of a stroke and/or death significantly.

Useful web addresses

www.nice.org.ukwww.bvf.org.ukwww.circulationfoundation.org.ukwww.vascularsociety.org.uk

Access to benefits

If you require information about benefits information can be foundon-www.direct.gov.ukwww.dwp.gov.ukor your local Benefits office.

Your Comments

Patient Advice and Liaison Service (PALS) Freephone 0800 0730510.

PALS is here to support patients, relatives or carers when theyhave concerns or queries. They will do their best to resolve anyconcerns you may have and can also give advice on making aformal complaint.

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Before your operation

Before the operation you will be asked to attend the surgicalassessment unit. Here you will be seen by a member of thesurgical team to assess your fitness for surgery.

Various investigations will be required such as an ECG (hearttracing), chest x-ray, echocardiogram Ultrasound scan of thecarotid artery and blood tests. A physical examination will also becarried out. Please bring any medication with you that you takeregularly. If you have any questions please don't hesitate to ask.

Coming into hospital

Surgery involves admission to hospital for about three to five days.Your admission will be on the day of surgery or 1day prior to thesurgery. Bring with you any medication you take, nightwear,toiletries and something to occupy your time such as readingmaterial.

Nursing staff will explain the layout of the ward and the generalroutine of the day, ask the ward staff about visiting times andtelephone numbers as these vary from ward to ward.

It is advisable not to bring valuables into hospital as these may getmisplaced. The morning of you operation you will be asked not toeat or drink for a minimum of 6 hrs before surgery. You will have abath or shower and you will be given a theatre gown to wear.

There are many good drugs that will control your high bloodpressure and diabetes. Aspirin or its substitute drugs will help theblood to be less sticky hopefully preventing any problems in thefuture with regards to clots.

Further Information

If you have any queries or require any further information you cancontact one of the numbers listed below:-

Mr Jayatunga - Consultant Vascular surgeonSecretary - Alison Slater Tel no - 01384 244243

Mrs Shiralkar - Consultant Vascular surgeon Secretary - Faye Langford Tel no - 01384 244246

Mr Pathak - Consultant Vascular surgeon Secretary - Maxine Winmill Tel no - 01384 244245

Mr Rehman - Consultant Vascular surgeon Secretary - Lara Golding Tel no - 01384 244176

Joy Lewis - Vascular Nurse SpecialistTel no - 01384 456111

Mark Black - Chief Vascular Scientist Tel no - 01384 456111

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The nursing staff will complete a checklist to ensure you areprepared safely for theatre.It is advisable to stop smoking as soonas possible but more importantly not to smoke on the day ofsurgery.

The operation

In the majority of cases the operation is performed under localanaesthetic. Although this is not pleasant; it is much safer as theblood flow to the brain can be monitored much more easily.

If you feel any discomfort tellthe surgeon and theanaesthetist will give you morelocal anaesthetic to make itcomfortable for you. There willbe someone who will sit next toyou and talk to you during theprocedure.

Once you have been anaesthetised a cut is made in the skin of theneck over the carotid artery. The artery is then temporarily clampedoff and the diseased lining removed. The artery is then closed. Onecontinuous stitch under the skin will be used to close the skin andthere may be a drainage tube placed which will be taken out after24 or 48 hours.

There is likely to be a numb area on the side of the neck thatmay take several months to settle down. Occasionally thisnumbness can be permanent.

Temporary weakness of the side of the mouth or tongue ispossible, although it is only very rarely permanent.

Sometimes a blood transfusion is necessary although this isuncommon.

There is a small risk of developing a stroke during theoperation combined with a very small risk of death. In GreatBritain, this combined "operative" stroke and death risk is lessthan 5%. Our results at Russells Hall are not dissimilar;however, you are more likely to avoid a major stroke in thelong run, if you undergo surgery. You may wish to discussthese risks with your Surgeon in more detail before theoperation.

Risks if surgery is not carried out

Those who have had a minor stroke or TIA as a result of narrowingin the neck arteries, there is a higher risk of having a major stroke.

What about afterwards?

The operation usually gives good long-term relief. You can alsohelp by improving your general health by taking regular exercise,stopping smoking and reducing the amount of fat in your diet. Allthese things will help reduce the chances of furthertrouble from arterial disease.

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The operation can be carried out using either of the proceduresshown overleaf. Your consultant will explain which procedure is tobe carried out.

Surgery Method 1

small dose of Aspirin if you are not already taking it. This makesthe blood less sticky. If you are unable to tolerate Aspirin analternative drug may be prescribed.

Regular exercise such as a short walk combined with rest isrecommended to provide a gradual return to normal activity.

Driving - You will be able to drive when you can perform anemergency stop safely. This will normally be 2-3 weeks aftersurgery, but if in doubt check with your own doctor.

Bathing - Before the stitches are taken out it is advisable to keepthe wound dry. Once the stitches are removed you can bathe orshower as normal.

Work - If this applies to you, you should be able to return to workwithin 3-4 weeks of surgery. Your G.P. will advise when he/sheissues a sick note.

Lifting - There are no limits in this area.

Are there any risks?

Operations on arteries can cause bleeding and occasionallyyou may have to return to the operating theatre.

Some minor bruising around the wound is common after theoperation.

Bruising of the neck may take several weeks to settle down.

Surgery Method 2 After the operation

You are more than likely to be awake during the whole operationand the various monitors and tubes that are used to monitor youwill be continued after surgery. You will usually be returned to aHigh Dependency Unit (HDU) so that we can keep a careful eye onyou for 24 hours. After this you will be returned to your own ward.

You will be allowed to drink almost immediately after your operationif it\'s been done under local anaesthetic. The operation site is notparticularly painful although you may need some painkillers, whichwill be given to you if required. In some cases, you may be able togive yourself medication and you will be shown how to do this.

Relatives are allowed to visit on the evening after surgery.

On the following day after surgery you will be allowed to get out ofbed and to eat normally.

Going home

In many cases, you may be allowed home on the second or thirdpost-operative day. If dissolvable stitches are used, these do notneed removing. If your stitches or clips are the type that needremoving and this is not done before you leave hospital,arrangements will be made for this to be done at home.

You may feel tired for a few weeks following surgery but this willgradually improve as time goes on. You are usually sent home on a

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