Thromboendarterectomy: Treatment, Effects & Risks

Thromboendarterectomy (TEA)refers to various surgical procedures to remove a blood clot or blood clot (thrombus) and restore the function of blood vessels after constriction or occlusion. TEA is used primarily for peripheral arterial disease and narrowing (stenosis) of the internal carotid artery. Various surgical techniques are available to remove the causative thrombus and restabilize the vessel walls in the area.

What is thromboendarterectomy?

Thromboendarterectomy refers to various surgical procedures to remove a blood clot or clot (thrombus) and restore the function of blood vessels after constriction or occlusion. Literally, thromboendarterectomy (TEA) means the removal of a thrombus, which is a blood clot or blood plug that has lodged in an artery and caused stenosis or total occlusion of the artery. Because the thrombus has usually attached itself to the walls of the vessel, the inner epithelium, the inner epithelium of the affected artery is usually removed as well. Various restabilization techniques are available to restore the artery‘s ability to function and bear weight after the thrombus is removed. The affected vessel walls can be resealed and stabilized with an autologous material from a vein wall, or a plastic patch can be used as a so-called patchplasty. In general, TEA is used to remove a stenosis of the internal carotid artery and to treat peripheral arterial disease (pAVK). PAD is also known as shop window disease or smoker’s leg because heavy smoking significantly increases the risk of disease.

Function, effect, and goals

Not only can an arterial stenosis or occlusion have serious effects on the part of the body that the artery must supply with blood, but there is also a risk that the thrombus or parts of it will break loose and be carried with the bloodstream to other parts of the body, where a new arterial stenosis or occlusion may form. If one of the neck arteries is affected, there is an acute risk of a clot lodging in the brain and causing a stroke because of an acute undersupply of oxygen and other essential substances to the affected nerve areas. The two most common uses of TEA are stenosis of the carotid arteries and treatment of peripheral arterial disease, which primarily affects the legs. Less common uses include treatment of mesenteric artery stenosis, which can lead to intestinal infarction with serious consequences. Also less common is the treatment of stenosis of the right and left pulmonary artery, the pulmonary artery using TEA. Four different surgical methods are available for performing TEA, depending on the diagnosis. These are the patch technique, eversion technique (EEV), direct occlusion, and fork transposition. The patch technique is used when parts of the internal vascular epithelium need to be replaced. When possible, the patch is made from the vessel wall of an endogenous vein or plastic patches made specifically for this purpose are used. If the conditions on the vessel walls of the opened artery allow it after TEA, the opened vessel walls are sutured with a continuous spacer suture in the so-called parachute technique. A suture that can be absorbed by the body tissue is usually used. The advantage of direct closure is that there is no need to make a patch from a vein in the body. However, there is a small risk that the artery may be slightly narrowed (stenosed) postoperatively. The eversion technique (EEV) represents a modern technique used mainly for carotids narrowed by more than 50%. After clamping the internal carotid artery, the internal branch is severed directly at the carotid bifurcation and the plaque cylinder is exposed and removed by inverting the vessel walls. The free end of the carotid branch is then re-sutured using the parachute technique without the use of any plastic patches or patches.Particularly for patients who have already experienced a so-called streak, short-term symptoms of a stroke, such an intervention can effectively prevent an impending stroke.

Risks, side effects, and dangers

In addition to the risks of infection or even infection with multidrug-resistant hospital germs that exist with all open surgery, TEA procedures-especially opening of the carotids-carry specific risks. Because the internal carotid artery to be treated is clamped immediately before the procedure, blood flow is interrupted and the brain regions to be supplied with oxygen and energy must be constantly checked for functionality. The procedure is usually performed under local anesthesia, so that the patient is constantly involved in small motor and denclogical tasks during the procedure. Another risk is that tiny microthrombi may break loose during the procedure, become lodged in the brain and trigger a stroke. Particularly in the case of severely calcified arteries – 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, necessitating special restructuring measures. Especially when treating the carotids, there is a fundamental risk of injuring adjacent structures during the procedure. Due to unintentional lesions of certain nerves such as the vagus nerve, the swallowing reflex as well as the voice may be disturbed in extreme cases. TEA also does not reliably rule out recurrence in the form of rethrombosis, although this usually becomes apparent within a few days. After removal of the inner epithelium of the treated artery, it forms anew within a few days (neointima). Therefore, the use of anticoagulant medications is recommended for prevention.