What Is an Endarterectomy?

Medically Reviewed by James Beckerman, MD, FACC on February 11, 2024
3 min read

If you have symptoms of peripheral artery disease (PAD) and medicines and lifestyle changes aren’t enough to control it, you might need surgery. An endarterectomy is one of the common surgeries doctors can use to treat your narrowed arteries, improve blood flow, and relieve symptoms of PAD.

The surgery involves removing fatty substances called plaques from your arteries. It’s most likely you’ll have this procedure if you have a lot of plaque and your arteries are severely narrowed.

Surgeons most often use an endarterectomy to open large blood vessels when there is a blockage or narrowing at places where your arteries branch off. Sometimes this can happen in the carotid arteries, the pair of blood vessels on both sides of your neck that send blood to your head and brain. Doctors call the procedure to remove plaque from the carotids a carotid endarterectomy.

Most endarterectomy procedures aim to restore blood flow to the femoral artery, which is in the top of your thigh. PAD is the most common condition that affects this artery. It’s a major blood vessel for carrying blood to your lower body and is important for normal blood flow to your legs. Your doctor may recommend you have a femoral endarterectomy depending on where your blockage is and how serious it is.

Your surgeon might do an endarterectomy at the same time as another procedure called bypass surgery. In bypass surgery, surgeons use part of one of your veins or a synthetic tube to create a new path for blood to flow around severely narrowed or blocked arteries. In PAD, bypass surgery can help to restore blood flow to your legs.

If you and your doctor have decided on an endarterectomy, your care providers will likely want to run some tests a few days before the surgery. These tests can make sure you can undergo surgery safely. You might need to stop taking certain medicines for a while. Ask your doctor if there’s anything else you should do to get ready for the procedure.

Your doctors will give you medicine to put you to sleep or to block pain to a specific part of your body so you won’t feel anything during surgery. A vascular surgeon will make a small cut where your blocked artery is. A tube or shunt near the artery they’re operating on will keep your blood flowing during surgery.

Next, they’ll make another incision to open up the narrowed artery and remove plaque from the artery walls with a tool called an endarterectomy spatula. They’ll then stitch the artery back up and take out the shunt. Your surgeon also may use a patch to help close your artery and encourage healing. These patches can be synthetic or made from your veins.

The procedure itself usually takes 2 or 3 hours. You should expect the whole process including preparation and recovery to take several more hours.

The goal of surgery is to restore blood flow, relieve discomfort or other symptoms of PAD, and prevent serious complications. Most of the time, endarterectomy works well and is safe.

You will likely be able to return to normal activities within weeks of your endarterectomy. Ask your doctor if they have any specific guidelines or recommendations to help you recover from surgery.

You may not notice any side effects from surgery. Some people have some numbness around their incision. Your doctor will follow up with you after surgery. They’ll explain how it went and what you can do to help prevent more plaque from building up in your arteries.

Any surgery comes with some risks, but endarterectomies don’t usually have complications. Ask your doctor about any special risks or concerns in your case. Sometimes an artery that’s been cleared surgically can get blocked again. Talk to your doctor about treatments and lifestyle changes that will make this less likely.

The best ways to keep all of your blood vessels healthy are to:

  • Eat a healthy diet.
  • Exercise regularly.
  • Limit salt, cholesterol, and unhealthy or saturated fats.
  • Control your blood pressure.
  • Don’t smoke.
  • Don’t drink too much alcohol.

Call your doctor right away if you notice any of the following symptoms, which could signal a sudden blockage of your femoral artery:

  • You can’t move your leg.
  • Your leg is numb.
  • You have sudden, severe leg pain.
  • Your leg suddenly feels cold.
  • Your leg looks unusually pale or blue.