CHAPTER 93

Endarterectomy

Endarterectomy is the surgical removal of the intimal lining of the artery. This procedure is performed to clear a major artery that may be blocked by plaque accumulation. The most common arteries needing endarterectomy are the carotid (neck) and the femoral (groin).

Possible equipment needed for the procedure includes femoral-to-popliteal artery bypass instruments, DeBakey tunnelers, 2 Cooley coarctation clamps, 1 Hollman tunneling forceps, and possibly a synthetic graft.

93-1 Endarterectomy instruments in the sterilization container. (Courtesy Case Medical Inc., South Hackensack, New Jersey.)

93-2 A, Femoral artery shows blockage in the main artery and deep femoral artery in the groin. B, Following endarterectomy of both arteries, the contrast shows arteries with increased blood supply.

93-3 Left to right: using contrast in the femoral artery, the three photos on the left side show blockage of plaque in the groin, thigh, and just above the knee. The three photos on the right side show great improvement in the blood supply following the endarterectomy.

Artery Bypass Graft

Possible equipment needed for the procedure includes a DeBakey tunneler, 2 Cooley coarctation clamps, 1 Hollman tunneling forceps, and a synthetic graft.

A brief description of the procedure follows:

1. A Bard-Parker scalpel handle #3 with #11 blade is used to incise into the popliteal artery.

2. Potts-Smith scissors (45 degrees) are used to extend the incision in the artery.

3. DeBakey vascular forceps are used to clamp the popliteal artery.

4. A DeBakey tunneler is used to make a passage beneath the sartorius muscle for the graft from the popliteal artery to the femoral artery.

5. A Bard-Parker scalpel handle #7 with #11 blade is used to make a small incision into the femoral artery.

6. Potts-Smith scissors are used to extend the incision.

7. A Cooley coarctation clamp is used to occlude the femoral artery.

8. Hollman tunneling forceps are used to pull the graft into position.

9. An Ayers needle holder is used for the suturing of the graft.

10. DeBakey tissue forceps are used to help with the suturing.

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