Treatments & Therapies

Thrombendarterectomy – Treatment, Effect & Risks

Thrombendarterectomy

thromboendarterectomy ( TEA ) involves various surgical procedures to remove a blood clot or blood clot (thrombus) and to restore the functionality of blood vessels after narrowing or blockage. TEA is mainly used for peripheral arterial occlusive disease and narrowing ( stenosis ) of the internal carotid artery (arteria carotis interna). Various surgical techniques are available to remove the causative thrombus and to restabilize the vessel walls in the area.

What is thrombendarterectomy?

Literally, thrombendarterectomy (TEA) means the removal of a thrombus, i.e. a blood clot or blood clot, that has become lodged in an artery and has caused a stenosis or complete blockage of the artery. Since the thrombus has usually attached itself to the vessel walls, the inner epithelium , the inner epithelium of the affected artery is usually also removed.

Various restabilization techniques are available to restore the artery’s ability to function and bear weight after the thrombus has been removed. The affected vascular walls can be closed and stabilized again with an endogenous material from a vein wall, or a plastic patch is used as a so-called patch plastic. As a rule, a TEA is used to remove a stenosis of the internal carotid artery and to treat peripheral arterial disease (PAD). PAD is also known as claudication or smoker’s leg because heavy smoking significantly increases the risk of developing the disease.

Function, effect & goals

An arterial constriction or blockage can not only have serious repercussions for the part of the body that must supply blood to the artery , but there is also a risk that the thrombus or parts of it can become detached and be carried by the bloodstream to other parts of the body where a new arterial stenosis or occlusion can form. If one of the cervical arteries is affected, there is an acute risk of a clot settling in the brain and causing a stroke because the affected nerve areas have become acutely undersupplied with oxygen and other essential substances.The two most common areas of application for a TEA are stenoses in the carotid arteries (carotid arteries) and the treatment of peripheral arterial occlusive disease, which mainly affects the legs . Less common areas of application are the treatment of mesenteric artery stenosis, which can lead to an intestinal infarction with serious consequences. Also less common is the treatment of a stenosis of the right and left arteria pulmonalis, the pulmonary artery by means of TEA.

Four different surgical methods are available for performing a TEA, depending on the diagnosis. These are the patch technique, the eversion technique (EEV), the direct closure and the forked transposition. The patch technique is used when parts of the inner vascular epithelium need to be replaced.

If possible, the patch is made from the wall of an endogenous vein or plastic patches specially made for this purpose are used. If the conditions on the vessel walls of the opened artery after the TEA allow it, the opened vessel walls are sutured with a continuous spacer suture using the so-called parachute technique. A thread that can be absorbed by the body tissue is usually used. The advantage of the direct closure is that no patch has to be made from an endogenous vein. However, there is a small risk that the artery will be slightly narrowed (stenosed) postoperatively.

The eversion technique (EEV) is a modern technique that is mainly used for carotids that are more than 50% narrowed. After clamping the internal carotid artery, the inner branch is severed directly at the carotid bifurcation and the plaque cylinder is exposed and removed by turning the vessel walls inside out. The free end of the carotid branch is then resutured using the parachute technique without the use of any plastic patches or patches. Such an intervention can effectively prevent an impending stroke, especially for patients who have already experienced so-called grazing, short-term symptoms of a stroke.

Risks, side effects & dangers

In addition to the risks of infection or even an infection with multi -resistant hospital germs that exist with all open surgeries, TEA interventions – especially the opening of the carotids – entail specific risks. Since the internal carotid artery to be treated is clamped off immediately before the procedure, the blood flow is interrupted and the brain regions that are to be supplied with oxygen and energy must be constantly checked for functionality.The procedure is usually carried out under local anesthesia , so that the patient is constantly entrusted with small motor and mental tasks. Another risk is that tiny microthrombi could become detached during the procedure, lodge in the brain and cause a stroke. In the case of severely calcified arteries in particular – this also applies to the arteries of the extremities – there is a risk that the vessel walls will tear due to the intimate connection between the plaques and the epithelia of the arteries during the removal of the plaques and necessitate special restructuring measures.

In the treatment of the carotids in particular, there is a fundamental risk that adjacent structures will be injured during the procedure. In extreme cases, the swallowing reflex and the voice can be disturbed by unintentional lesions of certain nerves such as the vagus nerve . A TEA also does not reliably rule out a recurrence in the form of rethrombosis, although this usually becomes apparent within a few days. After the removal of the inner epithelium of the treated artery, it forms again within a few days (neointima). To prevent this, it is recommended to take anticoagulant medication ( anticoagulants ).

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.