endarterectomy

DEFINITION of endarterectomy

Endarterectomy is an open vascular surgical procedure in which the surgeon incises an artery, then dissects and removes the atheromatous plaque along with the pathologically thickened tunica intima and inner tunica media, leaving the outer adventitia intact to serve as the new vessel wall. A patch angioplasty (using vein, synthetic, or bovine pericardial graft material) is often used to close the arteriotomy and prevent re-stenosis. The most common application is the carotid endarterectomy (CEA), performed to reduce stroke risk in symptomatic or significant asymptomatic carotid stenosis. It is also performed on the femoral, popliteal, and other peripheral arteries for limb-threatening ischemia. The procedure was pioneered by Dr. Michael DeBakey in 1953. Endarterectomy is distinct from bypass grafting (which routes blood around the obstruction) and angioplasty/stenting (endovascular approaches).

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ETYMOLOGY of endarterectomy

greek

Component	Origin	Meaning
end-	Greek endon (ἔνδον)	Within, inner
arteri-	Greek artēria (ἀρτηρία)	Artery (“windpipe” or “air carrier” — ancient Greeks thought arteries carried air)
-ectomy	Greek ektomē (ἐκτομή), from ek- (out) + temnein (to cut)	Surgical removal, excision

Literally: “surgical removal of the inner [lining of the] artery” — precisely describing the technique of coring out the diseased intima and plaque from within the vessel.

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🔀 ALIASES / ALTERNATE TERMS

• CEA — Carotid Endarterectomy (most common form)
• Carotid artery surgery
• Thromboendarterectomy (TEA) — when thrombus is removed along with plaque; often used interchangeably
• Carotid plaque removal
• Femoral endarterectomy — for peripheral artery disease of the femoral artery
• Aortoiliac endarterectomy — for aortoiliac occlusive disease (Leriche syndrome)
• Coronary endarterectomy — rarely performed adjunct to CABG for diffusely diseased vessels
• Pulmonary thromboendarterectomy (PTE/PEA) — for chronic thromboembolic pulmonary hypertension (CTEPH)
• Gas endarterectomy — historical technique using CO₂; largely obsolete

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🔗 RELATED TERMS

• Atherosclerosis / Atheromatous plaque — the pathology being treated
• Carotid stenosis — primary indication for CEA
• Intima — the arterial layer being removed
• Arteriotomy — the incision made into the artery
• Patch angioplasty — closure technique to widen the vessel after plaque removal
• Shunt (carotid) — temporary bypass of blood during CEA to maintain cerebral perfusion
• Carotid stenting (CAS) — the endovascular alternative to CEA
• TIA / Stroke — primary indications/feared outcomes driving CEA decisions
• NASCET / ACAS trials — landmark studies defining criteria for CEA (>70% symptomatic stenosis; >60% asymptomatic stenosis)
• Peripheral artery disease (PAD) — indication for femoral/popliteal endarterectomy
• Leriche syndrome — aortoiliac occlusive disease; may be treated with aortoiliac endarterectomy or bypass
• Re-stenosis — recurrent narrowing after endarterectomy; can occur months to years later
• Cranial nerve injury — known complication of CEA (hypoglossal, vagus, marginal mandibular branch of facial nerve)

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CODING CORNER

🏥 ICD-10-CM CODES

(Primary diagnoses driving endarterectomy — endarterectomy itself is a procedure and does not have a diagnosis code)

Carotid Stenosis / Occlusion (most common CEA indication)

Code	Description
I65.21	Occlusion and stenosis of right carotid artery
I65.22	Occlusion and stenosis of left carotid artery
I65.23	Occlusion and stenosis of bilateral carotid arteries
I65.29	Occlusion and stenosis of unspecified carotid artery

Vertebral / Other Precerebral Stenosis

Code	Description
I65.01	Occlusion and stenosis of right vertebral artery
I65.02	Occlusion and stenosis of left vertebral artery
I65.03	Occlusion and stenosis of bilateral vertebral arteries
I65.8	Occlusion and stenosis of other precerebral arteries

Atherosclerosis (underlying disease)

Code	Description
I70.0	Atherosclerosis of aorta
I70.201	Unspecified atherosclerosis of native arteries, right leg
I70.202	Unspecified atherosclerosis of native arteries, left leg
I70.91	Generalized atherosclerosis

Cerebral Infarction (stroke — may be the indication or post-op complication)

Code	Description
I63.231	Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
I63.232	Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries

TIA

Code	Description
G45.1	Carotid artery syndrome (hemispheric) — TIA
G45.9	Transient cerebral ischemic attack, unspecified

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🔧 COMMON CPT CODES

Carotid Endarterectomy

CPT Code	Description
35301	Thromboendarterectomy, carotid, vertebral, subclavian by neck incision
35390	Reoperation, carotid, thromboendarterectomy, more than 1 month after original operation

Other Arterial Endarterectomy

CPT Code	Description
35302	Thromboendarterectomy, superficial femoral artery
35303	Thromboendarterectomy, popliteal artery
35304	Thromboendarterectomy, tibioperoneal trunk artery
35305	Thromboendarterectomy, tibial or peroneal artery, initial vessel
35306	Thromboendarterectomy, tibial or peroneal artery, each additional vessel
35311	Thromboendarterectomy, subclavian artery
35321	Thromboendarterectomy, axillary-brachial
35331	Thromboendarterectomy, abdominal aorta
35341	Thromboendarterectomy, mesenteric, celiac, or renal artery
35351	Thromboendarterectomy, iliac
35355	Thromboendarterectomy, iliofemoral
35361	Thromboendarterectomy, combined aortoiliac
35363	Thromboendarterectomy, combined aortoiliofemoral

Pulmonary Thromboendarterectomy

CPT Code	Description
33916	Pulmonary endarterectomy, with or without embolectomy, with cardiopulmonary bypass

Coronary Endarterectomy (adjunct to CABG)

CPT Code	Description
33572	Coronary endarterectomy, open, any method, performed in conjunction with CABG

Related Diagnostic Imaging

CPT Code	Description
93880	Duplex scan of extracranial arteries, bilateral (pre-op carotid evaluation)
93882	Duplex scan of extracranial arteries, unilateral or limited
70498	CT angiography, neck
70549	MRA neck with and without contrast
95925	Short-latency somatosensory evoked potential (SSEP) — intraoperative neuromonitoring during CEA

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⚠️ Coding Note: Endarterectomy is a procedure and is captured in ICD-10-PCS for inpatient coding rather than ICD-10-CM. The diagnosis codes above represent the indications for the surgery. For inpatient records, the principal procedure will be found under ICD-10-PCS root operation “Extirpation” (taking out or cutting out solid matter from a body part), applied to the specific arterial body part (e.g., carotid, femoral, iliac). CEA (CPT 35301) is one of the most commonly audited vascular procedures — always verify laterality, whether a patch was used, whether a shunt was placed, and whether reoperation applies (35390. Intraoperative neuromonitoring (SSEP/EEG) is separately reportable when performed and documented by a qualified provider.

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DERIVATIONS of endarterectomy

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Query functionality

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Med roots Appendix A Prefixes Appendix B Combining Forms Appendix C Suffixes Appendix D Suffix forms