Endarterectomy: Procedure, Types, Risks and Recovery Explained
Updated: 6 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review
Quick Answer: What is an endarterectomy?
An endarterectomy is a surgery that removes fatty, calcified plaque from inside a narrowed or blocked artery to restore blood flow. It treats moderate to severe atherosclerosis, mainly peripheral artery disease in the legs or arms and carotid artery disease in the neck. Results usually last many years, though recovery takes several weeks. [1]
What the research says
Groin-artery endarterectomy keeps the vessel open in most patients. A meta-analysis of 42 studies found that 92% of femoral-bifurcation arteries treated with endarterectomy stayed open at 12 months, compared with 85% after endovascular treatment; the gap was not statistically significant, and complications around the procedure were 16% versus 9%. (Hoffmann-Wieker et al., Dtsch Arztebl Int, 2022) [2]
Open repair may last longer than stenting in the common femoral artery, though head-to-head studies found no 1-year difference. Pooling 28 studies (about 3,800 patients plus 197 in randomized trials), arteries stayed open in 93.4% of patients at 1 year and 90.5% at 3 years after open surgery, versus 81.9% and 75.1% after endovascular repair; re-narrowing was 4.7% versus 14.4%, while short-term complications were lower with the endovascular approach. (Boufi et al., J Vasc Surg, 2021) [3]
In the neck, endarterectomy carries a lower early stroke risk than stenting. Across 7 randomized trials of 7,230 people with narrowed carotid arteries but no symptoms, stenting raised the odds of any stroke around the procedure by 62% (OR 1.62) compared with endarterectomy, while long-term rates of stroke, death and heart attack were similar. (Wang et al., Stroke, 2022) [4]
Key takeaways
Endarterectomy is open surgery: the surgeon cuts over the artery and lifts the plaque out. [1]
It is mainly used for moderate to severe, symptomatic artery narrowing. [1]
Hospital stay ranges from about 1 day (carotid) to about 10 days (pulmonary). [1]
Most people return to work after a check-up about 4 weeks later. [1]
Results usually last for many years. [1]
What is an endarterectomy used to treat?
An endarterectomy is used to treat atherosclerosis, the plaque buildup that stiffens and narrows arteries, usually when the disease is moderate to severe and causing symptoms. [1] Plaque is a fatty, calcified substance. Removing it improves blood flow and lowers the risk of blood clots and stroke. [1]
The two main conditions it treats are:
Peripheral artery disease (PAD): plaque in the arteries of the legs or arms. Left untreated, it can cause pain, wounds and tissue death (gangrene). [1]
Carotid artery disease: plaque in the neck arteries that supply the brain. It can lead to a stroke, a transient ischemic attack (TIA) or temporary blindness. [1]
To understand how plaque forms in the first place, read our guide to arteriosclerosis and atherosclerosis.
What are the types of endarterectomy?
The type of endarterectomy depends on which artery is blocked. [1]
Type | Artery treated | How often |
Carotid | Neck arteries that carry blood to the brain | Common |
Femoral | Groin arteries that carry blood to the legs | — |
Aortic and iliac | Main arteries of the belly and pelvis | — |
Coronary | Arteries that supply the heart | — |
Visceral | Arteries to the intestines and kidneys | Rare |
Pulmonary | Lung arteries (removes chronic blood clots, not plaque) | Rare |
Source: [1]
Who is not a candidate for an endarterectomy?
An endarterectomy may not be safe for people with conditions that make open surgery more dangerous. [1] These include:
Decompensated congestive heart failure
A recent heart attack
Symptomatic coronary heart disease that cannot be repaired
Severe emphysema or COPD
Radiation damage or infection in the surgical area
Extensive calcification
For these patients, a doctor may remove the blockage through a less invasive procedure called atherectomy, or open it with a stent. [1]
How do you prepare for an endarterectomy?
Preparing for an endarterectomy starts with imaging tests that show where the blockage is and how much blood gets through. [1]
Test | What it does |
Doppler ultrasound | Uses sound waves to locate blockages and measure blood flow |
CT angiography | Uses X-rays and IV contrast dye to build a 3D picture of the vessels |
Angiography | Uses X-rays and dye injected directly into the arteries |
Magnetic resonance angiography (MRA) | Uses magnets and radio waves to image the vessels |
Source: [1]
Your care team may also:
Check your heart with an echocardiogram or stress test to judge heart attack risk. [1]
Ask you to pause blood thinners (anticoagulants), or start an antiplatelet such as aspirin. [1]
Tell you how long to fast before surgery. [1]
Never stop or start a medicine on your own — follow your surgical team's instructions.
How is an endarterectomy performed?
An endarterectomy is performed through a cut directly over the blocked artery, after which the surgeon removes the plaque and closes the vessel. [1] Most people have general anesthesia and are asleep. Some have regional anesthesia (such as a spinal block) or local anesthesia while awake. [1]
Local anesthesia is most often used for carotid endarterectomy, so the team can check brain function during surgery. A small tube (shunt) may keep blood flowing to the brain while the artery is open. [1]
The four main steps: [1]
The surgeon makes an incision over the blocked artery.
The plaque is removed from inside the artery.
The artery is closed with stitches, sometimes with a patch to widen it and prevent re-narrowing. The patch may be synthetic or a piece of your own healthy vein.
The skin incision is closed.
How long does it take? A carotid endarterectomy takes about 1 to 2 hours. Other types vary with the anesthesia used and your health conditions. [1]
What are the benefits and risks of an endarterectomy?
The main benefit of an endarterectomy is that it removes the blockage and returns the artery to its normal, healthy size. [1] A cleared artery can help:
Heal leg wounds
Relieve leg pain when walking (claudication)
Ease belly pain caused by poor circulation
Significantly lower stroke risk (carotid surgery)
Results usually last for many years. [1]
Possible complications are uncommon in most people but include: [1]
Complication | Note |
Bleeding | — |
Heart problems | Including heart attack |
Infection | At the incision site |
Nerve damage | Often temporary |
Re-narrowing | The artery can narrow again |
Stroke | — |
Factors that raise your risk: older age, untreated coronary artery disease or chest pain (angina), severe lung disease, decompensated heart failure, previous surgery or radiation in the same area, and plaque in many arteries. [1] For carotid blockages, some data show endarterectomy is safer than stenting. [1][4]
How long is recovery after an endarterectomy?
Recovery after an endarterectomy usually takes several weeks, and the hospital stay depends on which artery was treated. [1]
Type | Typical hospital stay |
Carotid | About 1 day |
Femoral | 2 to 4 days |
Aortic or visceral | About 1 week |
Pulmonary | About 10 days |
Source: [1]
Right after surgery: a small drain may sit in the wound to limit bruising; it is removed before you go home. You can usually eat and drink within a few hours unless the cut is in your belly. Some numbness or pain near the incision is normal. [1]
Medicines: you may take antiplatelets or anticoagulants for several months. After pulmonary endarterectomy, blood thinners are lifelong. [1]
Back to normal life: [1]
About 4 weeks: follow-up visit; most people return to work after it.
6 weeks or more: recovery time after aortic, visceral or pulmonary endarterectomy.
1 to 2 months: wait before returning to manual or strenuous work.
2 months: no lifting over 10 pounds (about 4.5 kg) after aortic or visceral surgery.
Gentle activity helps healing, but avoid strenuous exercise until your doctor clears you. After leg surgery, your doctor may check your ankle-brachial index every 6 months, and the repair is followed with ultrasound or CT scans. [1]
Life expectancy depends on which artery was treated. The biggest long-term threat is heart-related, such as a heart attack, so your doctor is the best person to discuss your outlook. [1]
When should you call a doctor after an endarterectomy?
Call your doctor right away after an endarterectomy if you notice any sign of a complication. [1]
Chest pain or trouble breathing
Fever or chills
Numbness or weakness
Swelling, more redness or discharge at the incision
Vision changes, slurred speech or a drooping face
Nausea or vomiting
Sudden face drooping, slurred speech or one-sided weakness can mean a stroke — call emergency services immediately.
How is an endarterectomy different from angioplasty, atherectomy and thrombectomy?
An endarterectomy differs from these procedures because it is open surgery that cuts directly into the artery to pull plaque out. [1]
Procedure | What it does | Approach |
Endarterectomy | Surgically removes plaque (rarely, clots) | Open surgery |
Angioplasty | Pushes plaque against the artery wall (sometimes destroys it with a laser) | Minimally invasive |
Atherectomy | Removes plaque with a tool at the tip of a catheter | Minimally invasive |
Thrombectomy | Removes blood clots only | Varies |
Source: [1]
When leg arteries are too damaged for plaque removal, surgeons may reroute blood instead — see our guide to peripheral artery bypass. For a broader look at symptoms of reduced blood flow, read about poor circulation.
Conclusion
An endarterectomy clears plaque from a narrowed artery so blood can flow freely again. It is major surgery with a recovery of several weeks, but serious complications are uncommon and results usually last for years. [1] Research shows strong long-term patency for groin-artery repairs and a lower early stroke risk than stenting for carotid disease. [2][3][4]
If your doctor has recommended an endarterectomy, write down your questions — about the type you need, your hospital stay, your medicines and when you can work again — and bring this guide to your appointment.
Want more clear, research-backed health guides? Explore the Rinnit health library and share this article with anyone preparing for artery surgery.
FAQ
What is an endarterectomy?
An endarterectomy is a surgery that removes plaque from inside a narrowed or blocked artery to improve blood flow. It is used for conditions such as peripheral artery disease and carotid artery disease.
Is endarterectomy major surgery?
Yes. An endarterectomy is open surgery, so it is a major operation with a hospital stay of one to several days and recovery of several weeks to months. Complications of carotid or femoral endarterectomy are uncommon.
How long does an endarterectomy take?
A carotid endarterectomy takes about one to two hours. Other types vary depending on the artery, the anesthesia used and your health conditions.
How long is the hospital stay after an endarterectomy?
The hospital stay is about one day for carotid, two to four days for femoral, about one week for aortic or visceral, and about ten days for pulmonary endarterectomy.
When can I go back to work after an endarterectomy?
Most people return to work after a follow-up visit about four weeks after surgery. Jobs with manual labor may need one to two months, and aortic, visceral or pulmonary surgery needs at least six weeks of recovery.
What are the risks of an endarterectomy?
Risks include bleeding, heart attack, infection, nerve damage that is often temporary, re-narrowing of the artery and stroke. For most people the risk of serious complications is low.
Is endarterectomy the same as angioplasty?
No. An endarterectomy surgically removes plaque from the artery, while angioplasty is a minimally invasive procedure that pushes plaque against the artery wall.
When should I seek emergency care after an endarterectomy?
Seek care right away for chest pain, trouble breathing, numbness or weakness, vision changes, slurred speech, a drooping face, fever, or a red, swollen or leaking incision.
How do I prepare for an endarterectomy?
Your care team will review your medicines and tell you which ones to keep taking or pause, including blood thinners. Do not stop aspirin or other medicines unless they tell you to. If you smoke, stopping before surgery helps you heal.
Will I be awake during a carotid endarterectomy?
Some people have general anesthesia and are fully asleep. Others have numbing medicine in the neck and stay awake so the team can check their brain function during surgery. Your surgeon will explain which is best for you.
Related Reading
Carotid Endarterectomy: Surgery, Risks and Recovery explains carotid artery surgery to prevent stroke.
Carotid Angiography: Imaging Neck Arteries for Stroke Risk explains the X-ray dye test that shows narrowing in the neck arteries.
References
Cleveland Clinic. Endarterectomy: Procedure, Types & Purpose. Cleveland Clinic. Last updated May 14, 2025. https://my.clevelandclinic.org/health/treatments/17312-pad-endarterectomy
Hoffmann-Wieker CM, Ronellenfitsch U, Rebelo A, et al. Open surgical thrombendarterectomy versus endovascular treatment in occlusive processes of the femoral artery bifurcation. Dtsch Arztebl Int. 2022;119(47):803-809. PMID: 36424715. https://doi.org/10.3238/arztebl.m2022.0331
Boufi M, Ejargue M, Gaye M, et al. Systematic review and meta-analysis of endovascular versus open repair for common femoral artery atherosclerosis treatment. J Vasc Surg. 2021;73(4):1445-1455. PMID: 33098944. https://doi.org/10.1016/j.jvs.2020.10.026
Wang J, Bai X, Wang T, et al. Carotid stenting versus endarterectomy for asymptomatic carotid artery stenosis: a systematic review and meta-analysis. Stroke. 2022;53(10):3047-3054. PMID: 35730457. https://doi.org/10.1161/STROKEAHA.122.038994 Erratum in: Stroke. 2023;54(3):e122. PMID: 36848433. https://doi.org/10.1161/STR.0000000000000426
Nishibe T, Maruno K, Iwahori A, et al. The role of common femoral artery endarterectomy in the endovascular era. Ann Vasc Surg. 2015;29(8):1501-1507. PMID: 26148640. https://doi.org/10.1016/j.avsg.2015.05.005
Medical disclaimer
This article is for general education and does not replace advice from your own doctor or surgeon. Decisions about endarterectomy, medicines and recovery should be made with a qualified healthcare professional who knows your full medical history. If you have signs of a stroke or heart attack, call emergency services immediately.
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