Carotid endarterectomy Vascular Surgery Patient Information Leaflet
What is carotid endarterectomy? Every day in Great Britain many people have a stroke (CVA) or warning signs of a stroke (mini stroke or TIA). Such patients are at a higher risk of having another, perhaps a major stroke. All patients with an increased risk of stroke are given medical treatment and advice to reduce this risk. This includes treatment of high blood pressure, diabetes, high fat levels, heart disease and stopping smoking. In addition, aspirin or an alternative drug is generally given. However, in many cases, surgical treatment is also recommended. In these cases, such as yourself, there is a high degree of narrowing 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 the brain looks after the right arm and leg and the right side of the brain looks after the left arm and leg. For this reason, the patient often thinks that the wrong side is being operated upon when in fact it is the correct side. At present, we also know that the presence of a narrowing (stenosis) in your carotid artery makes the chances of suffering a stroke in the future much higher than in a person without such a narrowing. We also know that performing an operation called carotid endarterectomy (to correct the narrowing) will actually reduce the chances of a stroke and/or death significantly. Before your operation Before the operation you will be asked to attend the surgical assessment unit. Here you will be seen by a member of the surgical team to assess your fitness for surgery. 2
Various investigations will be required such as an ECG (heart tracing), chest X-ray, echocardiogram and ultrasound scan of the carotid artery and blood tests. A physical examination will also be carried out. Please bring any medication with you that you take regularly. 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 one day prior to the surgery. Bring with you any medication you take, nightwear, toiletries and something to occupy your time such as reading material. It is advisable not to bring valuables into hospital as these may get misplaced. Nursing staff will explain the layout of the ward and the general routine of the day. Please ask the ward staff about visiting times and telephone numbers as these vary from ward to ward. The morning of your operation you will be asked not to eat or drink for a minimum of six hours before surgery. You will have a bath or shower and you will be given a theatre gown to wear. The nursing staff will complete a checklist to ensure you are prepared safely for theatre. It is advisable to stop smoking as soon as possible but more importantly not to smoke on the day of surgery. 3
The operation In the majority of cases the operation is performed under local anaesthetic. Although this is not pleasant; it is much safer as the blood flow to the brain can be monitored much more easily. If you feel any discomfort tell the and the anaesthetist will give you more local anaesthetic to make it comfortable for you. There will be someone who will sit next to you and talk to you during the procedure. Once you have been anaesthetised a cut is made in the skin of the neck over the carotid artery. The artery is then temporarily clamped off and the diseased lining removed. The artery is then closed. One continuous stitch under the skin will be used to close the skin and there may be a drainage tube placed which will be taken out after 24 or 48 hours. The operation can be carried out using either of the procedures shown overleaf. Your consultant will explain which procedure is to be carried out. 4
Surgery method 1 5
Surgery method 2 6
After the operation You are more than likely to be awake during the whole operation and the various monitors and tubes that are used to monitor you will be continued after surgery. You will usually be returned to a High Dependency Unit (HDU) so that we can keep a careful eye on you for 24 hours. After this you will be returned to your own ward. You will be allowed to drink almost immediately after your operation if it s been done under local anaesthetic. The operation site is not particularly painful although you may need some painkillers which will be given to you if required. In some cases, you may be able to give yourself medication and you will be shown how to do this. Relatives are allowed to visit in the evening after surgery. On the following day after surgery you will be allowed to get out of bed and to eat normally. Going home In many cases, you may be allowed home on the second or third post-operative day. If dissolvable stitches are used, these do not need to be removed. If your stitches or clips are the type that need to be removed 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 will gradually improve as time goes on. You are usually sent home on a small dose of aspirin if you are not already taking it. This makes the blood less sticky. If you are unable to tolerate aspirin an alternative drug may be prescribed. Regular exercise such as a short walk combined with rest is recommended to provide a gradual return to normal activity. 7
Driving You will be able to drive when you can perform an emergency stop safely. This will normally be two to three weeks after surgery, but if in doubt check with your own doctor. Bathing Before the stitches are taken out it is advisable to keep the wound dry. Once the stitches are removed you can take a bath or shower as normal. Work If this applies to you, you should be able to return to work within three to four weeks of surgery. Your GP will advise when he/she issues a sick note. Lifting There are no limits in this area. Are there any risks? Operations on arteries can cause bleeding and occasionally you may have to return to the operating theatre. Some minor bruising around the wound is common after the operation. Bruising of the neck may take several weeks to settle down. There is likely to be a numb area on the side of your neck that may take several months to settle down. Occasionally this numbness can be permanent. Temporary weakness of the side of the mouth or tongue is possible, although it is only very rarely permanent. 8
Sometimes a blood transfusion is necessary although this is uncommon. There is a small risk of developing a stroke during the operation combined with a very small risk of death. In Great Britain, this combined operative stroke and death risk is less than five per cent. Our results at Russells Hall are not dissimilar; however, you are more likely to avoid a major stroke in the long run, if you undergo surgery. You may wish to discuss these risks with your in more detail before the operation. review Risks if surgery is not carried out Under What about afterwards? regards to clots. For those who have had a minor stroke or TIA as a result of narrowing in the neck arteries, there is a higher risk of having a major stroke. The operation usually gives good long-term relief. You can also help by improving your general health by taking regular exercise, stopping smoking and reducing the amount of fat in your diet. All these things will help reduce the chances of further trouble from arterial disease. There are many good drugs that will control your high blood pressure and diabetes. Aspirin or similar drugs will help the blood to be less sticky hopefully preventing any problems in the future with 9
If you require any further information regarding our services or if you have any questions about the management of your condition, please contact your consultant or vascular nurse on the telephone numbers below. Russells Hall Hospital, Dudley Mr Jayatunga Mrs Shiralkar Mr Pathak Mr Rehman Mr Newman Mr Wall Joy Lewis/Sharron Vascular nurse Cole specialist New Cross Hospital, Wolverhampton Mr Garnham Mr Hobbs Paula Poulton/Val Vascular nurse Isgar specialist Tel: 01384 244243 Tel: 01384 244246 Tel: 01384 244245 Tel: 01384 244176 Tel: 01384 244243 Tel: 01384 456111 Ext 1235 Tel: 01384 456111 Ext 2456 (answer machine) Tel: 01902 695977 Tel: 01902 695971 Tel: 01902 695984 Manor Hospital, Walsall Mr Abrew Mr Khan Fiona Fox Vascular nurse specialist Tel: 01922 721172 Ext 7763 Tel: 01922 721172 Ext 6669 Tel: 01902 721172 Ext 7648 10
Useful web addresses www.nice.org.uk www.bvf.org.uk www.circulationfoundation.org.uk www.vascularsociety.org.uk Access to benefits If you require information about benefits information can be found on: www.direct.gov.uk www.dwp.gov.uk or your local benefits office. Your comments Patient Advice and Liaison Service (PALS) Freephone 0800 073 0510. PALS is here to support patients, relatives or carers when they have concerns or queries. They will do their best to resolve any concerns you may have and can also give advice on making a formal complaint. 11
review Under Originator: Mr Pathak, Consultant Vascular Surgeon; Joy Lewis, Vascular Nurse Specialist Date originated: September 2011 Date for review: September 2014 Version: 1 DGH ref: DGOH/PIL/00519 12