About this book
Carotid endarterectomy is surgery to clean out a carotid artery. These large blood vessels carry blood from your heart to your face and brain. The more you know about your surgery, the easier it is to get your mind and body ready for it. This book will tell you about the surgery and what to expect while you are in the hospital. It will answer many of your questions and help you think of new ones to ask your doctor or nurse.
Contents
Carotid artery disease 3 Before surgery 5 The surgery 9 After surgery 10 Recovery 11 Long term results 12
2
Carotid artery disease
A carotid artery can become hard and narrowed by plaque (fatty buildup). When this happens, less blood reaches the face or brain through that artery. This is called carotid artery disease. A clogged artery can cause an embolism. This is when a small piece of plaque breaks loose and blocks a small blood vessel in your head. An embolism is one cause of stroke.
embolism
plaque
The purpose of surgery is to reduce the risk of a stroke by cleaning the plaque out of a carotid artery. 3
Risks
The success rate for carotid endarterectomy is very high, but there are still some risks. Your chance for success depends on: n your overall health n how badly your artery is blocked Ask your doctor if you are at greater risk for any reason. You can use this space to write down what your doctor tells you.
Notes
4
Before surgery
Your doctor will ask about your health history. He or she will also ask about your family’s health history. You will have a physical exam and a number of tests done to make sure your body is ready. These may include: n blood tests n electrocardiogram (EKG or ECG) n urinalysis n ultrasound/doppler n chest X-ray n arteriogram (catheter study) Ask your doctor to explain the tests that you will have.
Things to know Fill out this box before you go to the hospital. Your doctor or nurse can help you. When must I be at the hospital? Where in the hospital am I supposed to go? What should I take to the hospital? Should I take any medicines before surgery? Will I need help after surgery? Can I drive home? Other questions:
5
Going to the hospital
You will most likely go to the hospital the morning of surgery. Before you go, write down some things for your nurses so they can take better care of you: n how to contact your family n if you are allergic to any foods or medicines n if you have problems seeing or hearing n who will be at home with you after your surgery n which foods you don’t like
No eating or drinking
Your stomach must be empty during surgery to keep you from vomiting. Do not eat or drink anything after midnight on the night before your surgery. If you need to take medicine, ask your doctor first. Most medicines may be taken with a few sips of water.
Note: Tell your doctor about every medicine you are taking—even aspirin. 6
Consent and advance directives
You will be asked to sign a consent form before your surgery. This explains what will be done in your surgery and the risks involved. If you don’t understand any part of the consent form, ask your doctor or nurse to explain it before you sign. By law, you must also be asked about advance directives. These are your choices about life support. You will be asked if you have a living will or a durable power of attorney (for health care). If you don’t understand these terms, ask a member of your health care team to discuss them with you.
C ON S FORENT M
7
The morning of surgery
You will be asked to remove: n dentures, hearing aids n hairpins, wig, hairpieces n jewelry n glasses, contact lenses n nail polish, makeup n underwear Ask your family to keep your things for you, or ask your nurse to keep them in a safe place. You may be given medicine before surgery. Before you take it, try to use the bathroom. Then stay in your bed or chair. The medicine will relax you and make you feel drowsy. It may also make your mouth feel dry. Your family can wait with you before you go to surgery. As they wait, they should sit quietly so you can relax and let the medicine work. When you go to surgery, they will be told where to wait so your doctor can find them.
8
The surgery
First, you will be given anesthesia. This is medicine that keeps you from feeling pain during surgery. You and your doctor will decide which type of anesthesia you will have. n Local anesthesia numbs the place where you will have your surgery—in this case, your neck. n General anesthesia puts you to sleep. After you are asleep (or the site is numb), your doctor will make a small cut in your neck. Then he or she will gently lift and open your carotid artery. A shunt (small tube) may be placed inside the artery. This allows blood to keep moving through your artery during surgery. After cleaning the inside of the artery, your doctor will close it with stitches or a special patch. The surgery takes about two hours.
shunt 9
After surgery
You will most likely go to either an Intensive Care Unit (ICU) or a recovery room. Your pulse and other body functions will be watched closely. If you have any problems such as bleeding or low blood pressure, they will be treated quickly. You may feel tired and hungry when you wake up, but you can’t eat anything right after surgery. You may be able to drink some fluids after about 6 to 8 hours. For most people there is very little pain after surgery. But if you have any, you will be given pain medicine. You will most likely be moved to a hospital room the morning after your surgery. Most people leave the hospital 1 to 2 days after surgery.
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Recovery
About 5 to 10 days after surgery, you will visit your surgeon. He or she will test your brain functions and make sure your wound is healing. The stitches or staples in your neck may also be removed. About 4 to 6 weeks later, you need to make another visit for noninvasive tests. Noninvasive means the tests are done with little or no discomfort or risk. You may be asked to see your primary care doctor to check your blood pressure and blood cholesterol levels. After these tests, your surgeon will most likely want to see you every six months. He or she will want to make sure your artery does not narrow again and may give you more tests.
11
Long term results
Carotid endarterectomy is very safe surgery—the success rate is over 95%. Patients who have the surgery may reduce their risk of stroke by as much as 70%. But surgery alone can’t keep you safe. To avoid strokes and other serious health problems, you may need to make some changes in your life. These changes include: n NO SMOKING! n Eat smart—avoid fatty foods. n Watch your blood pressure. Learn how to check your blood pressure at home. n Watch your weight. Drop extra pounds so your heart doesn’t have to work so hard. By making healthy choices in your life, you can increase your chances of having good health in the years after your surgery.
W
e believe that you have the right to know as much as you can about your health. Our goal is to give you enough facts to get the main points clearly in mind. We do this with medical accuracy, warmth and humor. The result for you: less tension, more healing and a good idea of what to ask your doctor,
Pritchett & Hull Associates, Inc. ‚
3440 Oakcliff Road, NE, Suite 110 Atlanta, GA 30340-3079 1-800-241-4925
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Copyright © 1997
by Pritchett & Hull Associates, Inc. All rights reserved. No part of this book may be photocopied, reprinted or otherwise reproduced without written permission from Pritchett & Hull Associates, Inc.
Author
Luis A. Queral, MD, FACS Director, Maryland Vascular Institute Baltimore, MD
Consultants
Mark G. Coan, MD, FACS Peachtree Vascular Specialists, P.C. Atlanta, GA Paul Collier, MD, FACS Director, Noninvasive Vascular Laboratory Sewickley Valley Hospital Sewickley, PA