Thrombendarterctomy

What is a thrombendarterectomy?

The term thrombendarterectomy (TEA for short) refers to the surgical removal of a blood clot from an artery. The procedure is considered if the clot severely narrows or even completely blocks the blood vessel.

This is usually due to blood clots that have lodged in the vessel wall ( medical term "thrombosis"), but other types of tissue, such as fat droplets or amniotic fluid, can also lead to arterial occlusion. Whatever the case, blockage of an artery reduces the supply of oxygen to the tissue lying behind it. Over the long term, this results in tissue damage and in the worst case, cell death.

Thrombendarterectomy aims to restore normal blood flow through the affected vessel and to widen the constriction. This procedure is only performed if the clot can no longer be dissolved with medication.

When is a thrombendarterectomy done?

A TEA is an option for various types of vessel occlusion, for example, PAD (peripheral arterial occlusive disease) or carotid stenosis, which is an occlusion of one of the arteries in the neck. However, TEA may also be a treatment option for pulmonary thrombosis or other vascular occlusions.

Normally, thrombendarterectomy is performed only if the vascular occlusion is very severe or can no longer be treated with blood thinning medication. This means an attempt should first be made to treat the thrombosis by other means. Moreover, surgical dilation of the vessel is not suitable for every patient. When choosing the treatment, It is always important to take into account the entire clinical picture and any physical limitations.

What happens during a thrombendarterectomy?

The types of thrombendarterectomy vary depending on the affected vessel, the size of the narrowing and the patients' overall condition. The most common types of TEA are open, semi-closed and closed.

In all three forms, the affected occluded portion of the artery is first clamped off from both sides of the remaining vessel to interrupt the blood flow.

In the case of an open TEA, the entire constriction is then cut open longitudinally and the thrombus can be peeled out and removed. Afterwards, the vessel is sealed again using a patch. This patch consists either of plastic or of the vessel wall of a patients' own vein in the body that has previously been prepared. It is important to use the patch to ensure that the inner diameter of the artery does not shrink after surgery because of scar tissue, threatening to narrow the artery again.

With a semi-closed or closed thrombendarterectomy, the initial incision will not be made along the entire constriction.

During a semi-closed TEA, only one section is opened in front of and one section behind the constriction, which means that the actual thrombus remains concealed and is peeled out through the openings. With closed TEA, just one incision is made - either upstream or downstream of the constriction - through which the thrombus is removed. With these two forms of TEA, the opening is also closed with a patch made from plastic or venous material.

Which risks are associated with a thrombendarterectomy?

Any operation involving blood vessels bears the risk of secondary bleeding, especially arterial surgery. An additional risk factor for possible bleeding are the permanent blood thinners that most patients need to take after TEA. Blood-thinning medication is important to prevent the operated site from closing up again and to prevent new constrictions from occurring elsewhere in the body. However, regular blood and wound checks are done after a thrombendarterectomy to identify and treat any bleeding as quickly as possible.

Moreover, after a TEA, the patch used to seal the vessel, as described above, can become inflamed or detach. Inflammation of the patch or the surgical suture of the overlying skin can result in sepsis in particularly severe cases. Sepsis is a severe immune reaction of the whole body that can lead to circulatory failure and, in the worst case, death. It is important to note, however, that not every inflammation results in sepsis and that sepsis is also prevented by regular medical check-ups.

An additional risk of thrombendarterectomy is that the operated blood vessel may close again. As the vessel wall is no longer perfectly smooth at the site of the surgical suture, blood constituents can adhere to the wall and form a thrombus again. If this happens, a second operation with a different surgical procedure, like a bypass, is usually necessary.

What should be considered after a thrombendarterectomy?

After a thrombendarterectomy, correct follow-up care is essential to prevent the artery from re-occluding. Most patients will need to take blood-thinning medication on a long-term basis. The material of the skin suture is usually self-dissolving, although it may be necessary to have it removed by your GP after about 10 days.

Depending on the condition, some additional measures should be integrated into everyday life to prevent further thrombosis. These measures include, for example, using anti-thrombosis stockings or following a healthier lifestyle overall. It is also important to have regular blood tests and blood pressure checks by your GP in order to detect and treat secondary diseases.

Which doctors and clinics specialize in thrombendarterectomy?

Since thrombendarterectomy is a surgical procedure, it is usually performed during an inpatient stay in hospital. The surgery itself is carried out by vascular surgeons, who are specialists in surgery with additional training in blood vessel surgery. They will also perform the first follow-up check after the operation.

Once patients have been discharged from the hospital, all further check-ups are usually done by your family doctor.

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of thrombendarterectomy and are looking forward to your inquiry or wish for treatment.