Endarterectomy: Procedure, Applications, Benefits & Risks

An endarterectomy is a surgical procedure that removes atherosclerotic plaque from the inner lining of an artery, restoring its lumen and blood flow. Plaque—composed of cholesterol, fatty substances, calcium, and cellular debris—accumulates over time, narrowing the artery and reducing oxygen delivery to downstream tissues.

Common Applications

• Carotid endarterectomy (CEA): Performed on the carotid arteries in the neck to prevent stroke in patients with significant stenosis (typically ≥70% symptomatic, ≥80% asymptomatic). This is one of the most studied and validated vascular procedures.
• Aortic endarterectomy: For atherosclerotic disease of the abdominal aorta, often combined with bypass or performed during aortic aneurysm repair.
• Femoral/popliteal endarterectomy: For localized femoral artery disease, particularly common femoral artery stenosis. Often combined with patch angioplasty to prevent restenosis.
• Iliofemoral endarterectomy: For iliac artery disease, sometimes as an alternative to stenting.

Procedure

Under general or regional anesthesia:

1. The surgeon makes an incision over the affected artery.
2. The artery is clamped above and below the plaque.
3. The artery is opened longitudinally, and the plaque is carefully dissected and removed from the arterial wall (the "endarterectomy plane").
4. The artery is closed, often with a patch (vein or synthetic) to widen the lumen and reduce restenosis risk.
5. Flow is restored and verified; incision closed.

Outcomes & Risks

Most patients experience significant symptom improvement and durable results, particularly for carotid and femoral endarterectomy. Success depends on artery location, plaque morphology, surgical technique, and patient factors.

Risks—though relatively low in experienced hands—include:

• Bleeding or hematoma
• Infection
• Arterial injury or dissection
• Cranial nerve injury (carotid CEA: hypoglossal, vagus, facial nerves)
• Stroke (perioperative risk 1–3% for CEA)
• Restenosis (recurrent narrowing) over time
• Anesthesia-related complications

Carotid endarterectomy has robust evidence for stroke prevention in appropriately selected patients. For peripheral applications, it remains a valuable option, especially for common femoral artery disease where stenting is less durable.