Carotid Endarterectomy Operation Patient Information
Author ID: Leaflet Number: Version: Name of Leaflet: Date Produced: Review Date:
HA/TI Surg 058 2 Carotid Endarterectomy Operation April 2015 April 2017
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This leaflet explains to you about the operation called carotid endarterectomy. It explains what is involved before, during and after the operation. It also explains what possible risks there are and how you can help to make your operation a success.
What is a carotid endarterectomy? This is the operation to treat a narrowed artery (called carotid artery) which supplies blood to the brain. The narrowing is caused by build-up of material within the artery wall. During the operation, this material is removed thus clearing out the artery.
Why do I need the operation? Every day in the UK, many people have a stroke or warning signs of a stroke including a mini stroke or a TIA (Transient Ischemic Attack). All patients who are at increased risk of stroke are given medical treatment and advice to reduce this risk. This may include treatment of heart disease, high blood pressure, diabetes, high cholesterol levels and help and advice to stop smoking. However, in some cases, surgical treatment is also recommended. This is when there is narrowing of the carotid artery. Narrowing of the artery is detected by doing a neck scan. Usually the operation is performed if the narrowing is more than 70%. At present, we know that the presence of a narrowing (stenosis) in the carotid artery, carries a much higher risk Carotid Endarterectomy Operation
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of a future stroke, compared to an artery without narrowing. We also know that performing a Carotid Endarterectomy significantly reduces the chances of future stroke and/ or death.
What complications may I get? Carotid endarterectomy operation is associated with potential significant complications. During the operation, there is about 2% risk of stroke which could be fatal. Some of the nerves in the neck may be injured causing hoarseness, facial weakness or distortion of your tongue. In addition, there are many complications of all operations including heart and chest problems and clot formation in a leg vein (DVT). There is less than 1% risk of death which can result due to a stroke or heart attack.
Alternatives There is a considerable amount of evidence that a carotid endarterectomy reduces the risk of a further stroke. The instance of a stroke, despite being on best medical care is in the order of 20%.
What happens before the operation? The decision to proceed with the surgery will be made in the surgical out-patient clinic and you will usually be given a date for the operation. You will be invited to attend a preoperative assessment clinic. At this clinic, you will be seen by a nurse who will complete a pre-operative screening assessment. This will include taking a medical history, anaesthetic history and organising blood tests, ECG (heart tracing) and obtaining the results of previous tests, e.g. angiograms, chest X-rays and echocardiograms etc. You should bring all your routine medication with you to this clinic. The nurse will explain to you what to expect on the ward before your operation, what will happen in theatre and what to expect after the operation, e.g. drips, drains, urinary catheter, oxygen therapy, pain relief and when you can start to eat and drink after the operation. If you are diabetic, you may need an insulin drip until you are able to eat and drink again. During this appointment, you will also be seen by an anaesthetist who will explain to you the anaesthetic options (general anaesthesia or local anaesthesia) and the associated risks.
How can I prepare for the operation? It is very important for you to prepare well for the operation. There is a lot you can do to improve your fitness prior to the operation. Smoking: If you smoke, you should try hard to give up completely before the operation. Continued smoking will cause further damage to your arteries and your operation is more likely to fail to prevent strokes and you are more likely to have complications from the operation. If you can stop smoking for a day or two, your blood cells can carry more oxygen around your body. If you can stop smoking six weeks prior to the operation, you are less likely to get a chest infection after the operation.
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Alcohol: It is advisable to reduce the amount of alcohol that you drink. Losing weight: If you are overweight, some of the risks of the operation and the anaesthetic are increased. Losing weight will reduce these risks. You should also consider a change in your diet by reducing the amount of fat that you eat. Exercise: Regular exercise will increase your fitness and strength. There is no need to push yourself; a regular walk at your own pace will boost up your stamina and improve your fitness for the operation.
Admission to hospital On admission to the ward, you will be welcomed by a nurse or receptionist. The nurse will check some details with you and will give you a wristband. The nurse will also check your notes to ensure all your tests and investigations are available. You will also be seen by a doctor who works with your consultant. If you have any chest or breathing problems, you may be seen by the physiotherapist to optimise your breathing to its best before and after the operation. You may be given advice about breathing exercises.
Preparing you for the day The previous evening, the area to be operated on will be shaved. You will not be allowed anything by mouth (except necessary medication) for six to eight hours before your operation. It will help to prevent you from vomiting under anaesthesia. Mouth wash is available to help your mouth feel fresher. On the morning of your operation day, you will be given a gown to wear. You will be visited by one of the nurses from the recovery department. They will care for you for a short while immediately after your operation before you return to the ward. You will be asked:
To remove any dentures or contact lenses.
To remove any jewellery except wedding ring (tape will be placed over this). Your jewellery can be safely stored and returned to you later
Not to wear any make-up or nail varnish and to remove hair grips or slides
To remove any false prosthesis if suitable
If you wear glasses or hearing aids, they may be worn until you get to theatre. They will be stored safely and returned to you later. A nurse will make sure that all your documentation and test results are in order. A special checklist is used to ensure nothing is overlooked. You will be asked the same questions by several staff en route to theatre. An hour or so before the operation, you may be given a tablet or injection to help you relax. It is referred to as a ‘pre-med’. When the time for your operation arrives, you will be escorted to theatre by a nurse and a porter. Carotid Endarterectomy Operation
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What happens in the anaesthetic room? There is a period of 20 to 30 minutes preparation before the anaesthetic begins. In this period, the anaesthetic assistant will attach monitoring machines which will measure your heart rate (sticky pads on your chest), blood pressure (inflatable cuff on your arm) and oxygen levels (small peg on your finger or ear lobe). The anaesthetist will numb your skin with a local anaesthetic before using a larger needle to insert a thin plastic tube (cannula) into a vein on the back of your hand or forearm (usually known as a drip) and also in the artery at your wrist (arterial line to measure your blood pressure). If you are having a local anaesthetic, the anaesthetist will clean the side of your neck with a cold antiseptic solution before injecting the local anaesthetic into your neck to numb it. The anaesthetist might use ultrasound scan to inject the local anaesthetic into your neck. If you are having the operation under local anaesthetic, the surgeon might also inject local anaesthetic into your neck during the operation if needed. For a general anaesthetic, you will be asked to breathe oxygen through a mask whilst the anaesthetist injects drugs into your “drip”. You will not be aware of anything else until after the operation is finished. Whilst you are anaesthetised, you will also have a breathing tube placed in your mouth. If you are having a general anaesthetic, we may also inject local anaesthetic into your neck when you are asleep to help with post-operative pain relief.
After the operation You will be taken to the ‘recovery suite’ where you will stay for about an hour or so. You will be looked after by specialist nurses. They will measure your blood pressure and heart rate every 15 minutes or so. You may at first have a small oxygen face mask in place. You will still have the drip (tube) into a vein in your arm which is used to give you drugs and fluids until you are able to eat and drink normally. You may also have a drain tube in your neck wound with a bottle on the end of it to collect blood. These are both removed when no longer needed, usually the next morning. When doctors and nurses are happy, you will be taken to the high dependency unit (HDU) for close monitoring. Here you will be made comfortable and can rest. You will return to ward the next day. The operation is not particularly painful though the amount of discomfort people feel varies. The nurses and doctors will ensure that pain is kept to a minimum. If you choose to have the operation under local anaesthetic or if you have the neck injection (for pain relief) with general anaesthetic, you should be relatively comfortable. Any medication you need to control pain is already available on the ward. It will be given promptly according to your needs. Some people find methods of relaxation like listening to quiet music or controlled breathing also useful. You may have a sore throat and the neck wound may make the moving of your neck painful at first, which may feel stiff for a few days.
When can I eat and drink? You will be encouraged to start eating and drinking as soon as possible provided you are not sick and are fully awake (after general anaesthetic).
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Going home When I can go home? You can expect to be in hospital for one or two days after the operation if otherwise well. The surgeon and the nursing team will advise when you are ready to go home. Please do not leave until you have been given instructions and your medication.
District nurse We will arrange for a district nurse to visit you after you return home to check your wound/ stitches and to arrange any further visits if necessary.
What should I do after going home? A period of recovery of two weeks is suggested after leaving hospital. This time is spent resting more than usual, such as having a sleep in the afternoon, and taking only gentle exercise like walking. After this period you can gradually return to normal activities. It is advisable to gradually increase the amounts of exercise that you undertake, lengthening the distances that you walk and the amount of tasks that you do.
Driving We recommend that you do not drive for at least 15 days following your operation, provided you have not had a stroke within the past month and are not still disabled, as advised by the DVLA (Driver and Vehicle Licensing Agency www.direct.gov.uk/driverhealth). You must be able to carry out an emergency stop comfortably. Driving too soon after an operation such as this may affect your insurance. If you are in any doubt about driving, please speak to your GP or the Vascular team. We also advise that you check your insurance policy details or contact your insurance company prior to resuming driving.
Bathing It is important to keep your wound area clean. This can be done with a daily bath or shower, patting the area dry with a clean towel. If a wound becomes red and there is a discharge, then you should seek advice from your GP as you may need antibiotics. If your wound is itchy, a moisturiser may help.
Going to work Getting back to work depends upon how you feel and the type of work you do. This could possibly be anything from four to six weeks. Ask your doctor about your personal circumstances.
Sick note If you require a medical certificate, please ask the nurses on the ward prior to discharge. Your GP can also give you a sick note after your discharge from the hospital. Carotid Endarterectomy Operation
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Coming back to clinic A follow-up appointment will be arranged for about four to six weeks after your discharge from the hospital. This may be at Wigan or Leigh.
What do I do if I feel unwell at home? In general, call your GP or the Out-of-Hours Doctors service. If you develop symptoms of a stroke or a severe, unremitting headache, you should return to the hospital or call 999. Likewise if you experience any pain or swelling in your calves, any shortness of breath or pains in your chest you must seek medical attention.
Conclusion This leaflet does not cover everything. We hope that you find it useful and that it will help towards making your stay less worrying. Remember, try to read these notes a few times before you come to the hospital for your operation and bring them along with you on admission.
Data protection The Trust will endeavour to ensure that your information remains secure and confidential at all times. The Data Protection Act 1998 explains how personal information should be processed and this applies to all information whether held on paper or electronically on computer systems. We must ensure that all personal information is processed fairly, lawfully and as transparently as possible so that you:
Understand the reasons for processing your personal information.
Give your consent for the disclosure and use of information where necessary
Gain trust in the way we handle your information
Understand your rights regarding the right to request access to the information we hold about you
The Caldicott Guardian, who is a senior health clinician, has the role to ensure we meet the highest standards for handling personal information at the Trust.
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Comments, Compliments or Complaints The Patient Relations/Patient Advice and Liaison Service (PALS) Department provides confidential on the spot advice, information and support to patients, relatives, friends and carers.
Contact Us Tel: 01942 822376 (Monday to Friday 9am to 4pm) The Patient Relations/PALS Manager Wrightington, Wigan and Leigh NHS Foundation Trust Royal Albert Edward Infirmary Wigan Lane Wigan WN1 2NN
Ask 3 Questions Become more involved in decisions about your healthcare. You may be asked to make choices about your treatment. To begin with, try to make sure you get the answers to three key questions: 1. What are my options? 2. What are the pros and cons of each option for me? 3. How do I get support to help me make a decision that is right for me?
This leaflet is also available in audio, large print, Braille and other languages upon request. For more information call 01942 773106. © Wrightington, Wigan and Leigh NHS Foundation Trust All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
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