Carotid endarterectomy is a surgical procedure to remove a build-up of fatty deposits (plaque), which cause narrowing of a carotid artery. The carotid arteries are the main blood vessels that supply blood to the neck, face and brain.
How serious is carotid artery surgery? CEA can have serious complications, including stroke, heart attack, and death. You are more likely to have complications if you are age 75 or older or if you have a serious medical condition, such as: Diabetes. Severe heart or lung disease.
I'm glad it's NOT bypass being considered here, even though CEA is bad enough.
My father had major heart surgery later in his life. He did not have any form of dementia though.
My brothers and I were greatly concerned and asked his surgeon if this was his father what would he do?
My father’s surgeon insisted that he would opt for surgery because my father would not live without it. So, we followed his advice.
My mother was on the fence about the surgery but supported my dad because he wanted to go ahead with the surgery.
Dad made it through the surgery fine, but unfortunately he had a stroke while still recovering in the hospital from the surgery. Daddy knew the risks beforehand and took the risk.
His remaining years were difficult for him after his stroke.
Like I said, these decisions are never easy to make.
My mother was not a risk taker and made sure that we knew that if she ever faced a situation where surgery was needed, she would not do it.
Mom’s doctor was extremely cautious and when mom had certain issues that could have been helped by surgery she didn’t hesitate to tell my mother that she didn’t think it was a good idea to have surgery past a certain age and would not ever recommend it. I appreciated her honesty.
All of my brothers have had numerous heart surgeries. My older brother is 71 and is so tired of dealing with his heart issues. It’s on ongoing concern for heart patients.
Nothing like having the admin of AC changing info the OPs write and then having US trying to make heads or tails out of it w/o the OP coming back to clarify FOR us, eh?
Life expectancy of Vascular Dementia depends the root cause and whether that is brought under control. These include
high blood pressure (hypertension) smoking an unhealthy diet high blood cholesterol lack of exercise being overweight or obese diabetes drinking too much alcohol atrial fibrillation – a type of irregular heartbeat (arrhythmia) – and other types of heart disease
And as the OP describes their mother as physically great for their age she could easily live another decade. I have the same questions as ElizabethY - if they will put in a stent that's a whole lot different than open heart surgery. My BIL's mom recently had a stent at age 89 and has recovered well (it was determined she'd never survive bypass surgery so the choice was basically stent or die, and was very difficult for the family)
Surely you are not talking about coronary bypass surgery for an 81 year old with moderate dementia at play? For any surgeon to even consider such a thing is beyond ludicrous, in my experience. My DH was 62 when he underwent triple bypass surgery; his breastbone was broken open and spread apart in order to access his heart, which was stopped and placed on the bypass machine for the duration of the 5 hour surgery. Veins were taken from his lower legs to use to replace the clogged arteries in his heart; that was a separate and painful surgery to recover from in and of ITSELF. His breastbone was wired shut after the surgery was over with, and his entire chest was black & blue for months afterward. He was totally out of it on Fentanyl and other opioids to manage his severe pain for a few days after the surgery, then sent home with a list as long as a roll of toilet paper of instructions for ME to follow in care for him. Including but not limited to daily weighing to make sure he wasn't retaining fluid, daily temperature, daily blood pressure readings, daily meds in the AM, afternoon & PM, a strict diet to follow which at first was a HIGH CALORIE HIGH FAT diet to help him regain the 30 lbs he dropped like a hot potato from the stress of the surgery, about 15 follow up appointments, a strict schedule of cardiac rehab across town 3x a week, and about 100 other things I can't recall off the top of my head.
Within 2 weeks time, DH found it harder & harder to breathe and his shortness of breath became a crisis situation. He had a pleural effusion which is a pocket of fluid built up (due to the enormity of the bypass) between his lung and chest cavity, which required ANOTHER large surgery to be performed to drain it and scrape his lung of the build up. He was hospitalized for another week for that situation, general anesthesia was used yet again, and that surgery was almost as difficult to recover from as the original bypass! To this day, he still does not have full lung capacity back & suffers shortness of breath from that pleural effusion.
It's absurd to even consider such a surgery for an elder with dementia, never mind an elder of 81 w/o dementia.
It would be a hard NO for me.
I prayed daily for God to take my mother who was suffering with vascular dementia and loudly asking TO die on a daily basis as a result. The last thing on earth I ever wanted to do was to extend her life in any way, shape or form.
You have written the script for my husband's by-pass surgery (quadruple)....even the age is the same. Pleural Effusion was also a nasty side affect that required yet another hospitalization and procedure. To think an 81 yr. old with mid stage dementia (been there as well) would undergo such a difficult surgery and recovery is unconscionable to even consider.
Since vascular dementia only has a 5 year life expectancy, why would you want to put her through this? And for what....to give her another maybe 6 months to live with her broken brain? I mean really. Let her live whatever time she has left in peace and without doctors poking and prodding her for no good reason. And yes, my late husband had vascular dementia, and lived only 3 years with it.
The most important question to ask is: What is the hoped-for outcome of this procedure? If it is to "improve" the health in hopes of prolonging the life of someone who already has mid-range dementia... this would be an easy "no" for me.
Is this for open-heart surgery where she'd be under general anesthesia, with a breathing tube, and on a bypass pump with a surgeon performing the procedure?
Or are they offering something like stenting of the coronary artery under mild sedation, where a cardiologist advances the equipment up to her heart from her leg or wrist artery (done inthe cardiac cath lab)? They would be doing the fixing the same route that they used to take the pictures to look for the blockages?
As I read this now I see the spelling has been corrected. I first thought you meant carotid artery. If you are speaking of coronary artery and a bypass is being considered I would not consider that for myself at 80 or for a loved one your elder's age. Again I wish you luck in this decision only you can make.
I found asking the doctor(s), "If this was your parent, what would you do?" Was a great way to make them give me honest information.
Asking specific questions about the odds of something happening during surgery, prognosis with and without surgery, potential for adverse reactions after surgery can get them to slow down and answer.
I don't know anyone that has had a heart procedure that didn't have a stroke afterwards. Just my experience.
Any doctor that won't give me information, is NOT treating me or my loved ones. That is a waving red flag that says they couldn't care less and they just want to operate for the experience. NOT on my watch.
My GFs father, diagnosed with ALZ, had this surgery and it did not help with his cognitively. An operation where anesthesia is used can make Dementia worse. It takes a while to leave the body in the elderly.
This is a hard decision. Alva is a Nurse so she is very aware what can happen. Make a list of pros and cons. The cons will probably win out.
I watched my mother suffer beyond description following a brutal hemorrhagic stroke. This surgery risks that, in a person whose mind is already confused and likely frightened by lack of understanding much of what’s going on around her. There is no good option or answer, perhaps consider the oath our doctor’s take, “first, do no harm” I wish you peace
Not to be too blunt, but eventually something gets us all. The decisions should be made based on how well the patient would tolerate the surgery, recover from the surgery, and their quality of life. Dementia throws another wrench in the whole thing.
My mother had congestive heart failure and various other issues including dementia, but eventually I had to make the decision that we were done with hospitals because she'd go nuts in hospitals. The staff at hospitals are terrible at dealing with dementia patients, so I finally said we'd treat whatever ailed her at her nursing home or not at all. (Had she fallen and broken a hip, that would have warranted a trip to the hospital, though.)
That's when we started hospice care, and it was wonderful. She had better care under hospice than she did in hospitals.
I think that only you can make the decision whether to go ahead with this surgery. While I as a nurse did not often see complications from it (recovery is often quick and without much pain at all) there is some chance of a stroke DURING the surgery when plaque is loosened. As stroke from a blocked carotid is what you are attempting to PREVENT, that risk should be recognized. Also, your loved one has a poor quality of life due to advancing dementia, and there is some chance that the administration of anesthesia may make this dementia a good deal worse. Like Barb, I would consider what your loved one's wishes might be were she able to make this decision for herself, and I think I would likely ask for Hospice consult. There is no good answer here. While your loved one is in danger of a stroke with this amount of blockage, she is also in danger of a stroke from its "cure", as well as from other complications from medications such as blood thinners. Strokes don't always kill; they often just make the remaining life more miserable. This isn't an easy question. And if the doctors don't have time to FULLY discuss risk and complication, choices and recommendations, then I definitely would not go forward with this surgery.
When I made this response I thought your spelling a bit off but thought you were speaking of Carotid Artery. If this is a coronary artery, which our admins I am assuming it has been corrected by indicate, no I would not do any bypass surgery nor accept it myself (I am 80). Way too risky for a person this age.
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Here is a link to what carotid artery surgery is all about:
https://www.choosingwisely.org/patient-resources/carotid-artery-surgery/
Carotid endarterectomy is a surgical procedure to remove a build-up of fatty deposits (plaque), which cause narrowing of a carotid artery. The carotid arteries are the main blood vessels that supply blood to the neck, face and brain.
How serious is carotid artery surgery?
CEA can have serious complications, including stroke, heart attack, and death. You are more likely to have complications if you are age 75 or older or if you have a serious medical condition, such as: Diabetes. Severe heart or lung disease.
I'm glad it's NOT bypass being considered here, even though CEA is bad enough.
Best of luck!
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My father had major heart surgery later in his life. He did not have any form of dementia though.
My brothers and I were greatly concerned and asked his surgeon if this was his father what would he do?
My father’s surgeon insisted that he would opt for surgery because my father would not live without it. So, we followed his advice.
My mother was on the fence about the surgery but supported my dad because he wanted to go ahead with the surgery.
Dad made it through the surgery fine, but unfortunately he had a stroke while still recovering in the hospital from the surgery. Daddy knew the risks beforehand and took the risk.
His remaining years were difficult for him after his stroke.
Like I said, these decisions are never easy to make.
My mother was not a risk taker and made sure that we knew that if she ever faced a situation where surgery was needed, she would not do it.
Mom’s doctor was extremely cautious and when mom had certain issues that could have been helped by surgery she didn’t hesitate to tell my mother that she didn’t think it was a good idea to have surgery past a certain age and would not ever recommend it. I appreciated her honesty.
All of my brothers have had numerous heart surgeries. My older brother is 71 and is so tired of dealing with his heart issues. It’s on ongoing concern for heart patients.
Wishing you the best in this difficult situation.
I MIGHT consider carotid artery surgery which can be done with minimal sedation.
BUT General Anesthesia, especially of the sort used for Open Heart procedures? No way, no how.
high blood pressure (hypertension)
smoking
an unhealthy diet
high blood cholesterol
lack of exercise
being overweight or obese
diabetes
drinking too much alcohol
atrial fibrillation – a type of irregular heartbeat (arrhythmia) – and other types of heart disease
And as the OP describes their mother as physically great for their age she could easily live another decade. I have the same questions as ElizabethY - if they will put in a stent that's a whole lot different than open heart surgery. My BIL's mom recently had a stent at age 89 and has recovered well (it was determined she'd never survive bypass surgery so the choice was basically stent or die, and was very difficult for the family)
Within 2 weeks time, DH found it harder & harder to breathe and his shortness of breath became a crisis situation. He had a pleural effusion which is a pocket of fluid built up (due to the enormity of the bypass) between his lung and chest cavity, which required ANOTHER large surgery to be performed to drain it and scrape his lung of the build up. He was hospitalized for another week for that situation, general anesthesia was used yet again, and that surgery was almost as difficult to recover from as the original bypass! To this day, he still does not have full lung capacity back & suffers shortness of breath from that pleural effusion.
It's absurd to even consider such a surgery for an elder with dementia, never mind an elder of 81 w/o dementia.
It would be a hard NO for me.
I prayed daily for God to take my mother who was suffering with vascular dementia and loudly asking TO die on a daily basis as a result. The last thing on earth I ever wanted to do was to extend her life in any way, shape or form.
Wishing you the best of luck.
I mean really. Let her live whatever time she has left in peace and without doctors poking and prodding her for no good reason.
And yes, my late husband had vascular dementia, and lived only 3 years with it.
Is this for open-heart surgery where she'd be under general anesthesia, with a breathing tube, and on a bypass pump with a surgeon performing the procedure?
Or are they offering something like stenting of the coronary artery under mild sedation, where a cardiologist advances the equipment up to her heart from her leg or wrist artery (done inthe cardiac cath lab)? They would be doing the fixing the same route that they used to take the pictures to look for the blockages?
Asking specific questions about the odds of something happening during surgery, prognosis with and without surgery, potential for adverse reactions after surgery can get them to slow down and answer.
I don't know anyone that has had a heart procedure that didn't have a stroke afterwards. Just my experience.
Any doctor that won't give me information, is NOT treating me or my loved ones. That is a waving red flag that says they couldn't care less and they just want to operate for the experience. NOT on my watch.
This is a hard decision. Alva is a Nurse so she is very aware what can happen. Make a list of pros and cons. The cons will probably win out.
I would almost, to be honest, be glad that she may have an OUT of the awful dementia that imprisons her.
But, that’s me. Watching my mother suffering with this awful condition is brutal for me. And, it’s brutal for her to be living with it.
My mother had congestive heart failure and various other issues including dementia, but eventually I had to make the decision that we were done with hospitals because she'd go nuts in hospitals. The staff at hospitals are terrible at dealing with dementia patients, so I finally said we'd treat whatever ailed her at her nursing home or not at all. (Had she fallen and broken a hip, that would have warranted a trip to the hospital, though.)
That's when we started hospice care, and it was wonderful. She had better care under hospice than she did in hospitals.
Like Barb, I would consider what your loved one's wishes might be were she able to make this decision for herself, and I think I would likely ask for Hospice consult.
There is no good answer here. While your loved one is in danger of a stroke with this amount of blockage, she is also in danger of a stroke from its "cure", as well as from other complications from medications such as blood thinners. Strokes don't always kill; they often just make the remaining life more miserable.
This isn't an easy question. And if the doctors don't have time to FULLY discuss risk and complication, choices and recommendations, then I definitely would not go forward with this surgery.