What is thromboendarterectomy?
Thromboendarterectomy (TEA) is a surgical procedure to open blood vessels that have been blocked by a blood clot (thrombus). In this procedure, the surgeon removes not only the thrombus, but also the inner wall layer of the artery. After a thromboendarterectomy, blood flows again to parts of the body that had a poorer blood supply or no blood supply at all due to the blockage.
Thromboendarterectomy is divided into three types:
- Direct (open) thrombendarterectomy
- Indirect closed thromboendarterectomy
- Indirect semi-closed thromboendarterectomy
When do you perform a thromboendarterectomy?
Carotid artery
If a longer section of the carotid artery is narrowed, vascular surgeons may consider thromboendarterectomy. Other treatment options include inserting so-called stents – vascular supports made of metal or synthetic fibers – that keep the blood vessel open or replacing the diseased section of carotid artery with an artificial vessel.
Leg arteries
In so-called peripheral arterial occlusive disease (pAVK), the femoral arteries are frequently affected by a sudden vessel occlusion caused by a blood clot. The lack of blood flow can cause the leg below the constriction to die, as it no longer receives sufficient blood supply. The arteries in the back of the knee or in the lower legs are also often affected. Depending on the extent of the narrowing, bypass surgery may be appropriate for treatment in addition to thromboendarterectomy.
Intestinal arteries
The arteries of the intestine are mostly occluded by migrating thrombi (embolus). In this case, patients suffer from severe abdominal pain, among other symptoms. A thromboendarterectomy on the affected arteries helps to preserve the intestine.
What is done during a thromboendarterectomy?
Before the actual operation, the treating surgeon thoroughly examines the vessel in question. In addition to ultrasound, X-ray examinations or magnetic resonance imaging are available to him for this purpose.
The operation itself is usually performed under general anesthesia, but local anesthesia is often sufficient. After the surgeon has washed, disinfected and sterilely draped the surgical area, he incises the skin with a scalpel. Depending on which form of thromboendarterectomy is chosen, the incisions differ.
Direct thromboendarterectomy
Here, the surgeon completely opens the affected section of blood vessel and the overlying skin. Using a surgical instrument (spatula), he removes the blood clot along with the inner arterial layer. To prevent re-narrowing, the surgeon often sews a piece of another vessel into the previously narrowed area. This so-called patch significantly increases the diameter of the artery.
Indirect thromboendarterectomy
After the artery is permeable again, the corresponding part of the body is x-rayed to check whether the narrowing has been removed.
What are the risks of a thromboendarterectomy?
A thromboendarterectomy is a complex surgical procedure with all the risks of surgery. Despite sterile procedures and preventive antibiotic administration, the tissue can become infected with germs. Bleeding can also occur during or after thromboendarterectomy. Depending on the severity of complications, further surgery may be necessary.
Generally, only arteries larger than five millimeters in diameter are large enough for thromboendarterectomy. Smaller blood vessels are at much higher risk for re-narrowing after surgery.
Nerve damage
Nerves often run alongside the arteries and can be injured during the operation. Typical symptoms then are heat sensation disturbances, numbness or paralysis. These are not always permanent, but usually require extensive treatment.
Bleeding in other parts of the body
Contrast medium allergy
Before X-raying the surgical area, the doctor injects an X-ray contrast medium that makes blood vessels visible and can trigger allergic reactions. Depending on the severity of the allergic reaction, circulatory support and anti-allergic medications are given.
Additional measures
If thromboendarterectomy is not sufficient to restore blood flow, other procedures are used. These include, for example, inserting a stent to keep the artery open or bypass surgery.
What do I need to know after a thromboendarterectomy?
Tell your doctor if you have sudden pain around the wound or if the dressing is bloody after a thromboendarterectomy. You must also report numbness or paralysis urgently, as these indicate reocclusion or nerve damage.
To strengthen the muscles, you will make your first attempts at walking soon after the thrombendarterectomy, and later you will be allowed to walk further distances with physiotherapeutic help.
