Considerations for Endarterectomy

  • Isolated focal lesions in large caliber and high-flow vessels (aorta and left common iliac artery)
  • No significant disease of the external iliac arteries
  • Avoidance of prosthetic material
  • Aortic endarterectomy is a durable alternative to aortic bypass grafting with specific criteria


Anatomic Landmarks


Materials and Instrumentation


Technique Video

Surgical Steps

Midline incision with a standard infrarenal aortic exposure

A standard midline exposure with a standard infrarenal exposure was performed. 


Exposure and Palpation of the Bilateral CIA, EIA, and IIA

The external, internal, and common iliac arteries were exposed.  The infrarenal and distal iliac arteries were controlled. The vessels were palpated to evaluate for calcification. 



An arteriotomy was created in the aorta and extended proximally to reveal aortic plaque in the aorta. 


The arteriotomy was extended proximally and distally into the left common iliac artery to remove the lesions in those vessels. 

Endarterectomy of the Aorta

An endarterectomy was performed 

Plaque was transected and removed.



Patch Angioplasty

A bovine pericardium was used to create an angioplasty of the artery and stitched using 4-0 Prolene. 






  1. Connolly JE, Price T: Aortoiliac endarterectomy: a lost art? Ann Vasc Surg. 2006;20:56-62.