Professional Documents
Culture Documents
• A-D
Classification
TASC II (2007)
Therapeutic Options
• Open
– Direct Revascularization
• Aortic endarterectomy
• Anatomic Bypasses
– Aorto-biiliac
– Aorto-bifemoral
– Extra-anatomic bypasses
• Axillo femoral
• Fem-fem
• Endovascular
– PTA
– Stenting
Aorto-Iliac Endarterectomy
Patient Selection
• Infection
• Young patients or small vessels
• Pts with Erectile Dysfunction due to proximal
hypogastric occlusive disease
– Higher rates of restored sexual function
• Most feasible in focal stenotic lesions in large-caliber,
high-flow vessels
• Fallen out of favor due to technical difficulty, significant
blood loss, poor durability, advancement of
endovascular therapy
Atherosclerotic disease limited to
distal aorta and bifurcation Completion Angiogram
Endarterectomy Technique
• Direct debulking technique that takes advantage of
pathologic localization of atherosclerosis to
intima/media
• Longitudinal arteriotomy
– Allows direct visualization of both endpoints as well as
endarterectomized surface
• 3 cleavage planes in operative setting:
– Subintimal
– Transmedial
– Subadventitial
• Subintimal predisposes to subsequent thrombosis
• Transmedial/Subadventital preferred
Endarterectomy Technique
• Residual outer layer generally of sufficient
mechanical strength to hold surgical sutures
and to resist disruption or enlargement