Endarteriectomy in the Treatment of Chronic Endarteritis Obliterans of the Limbs and Abdominal Aorta

Abstract

The authors performed 93 endarteriectomies for the treatment of chronic endarteritis obliterans after prolonged conservative therapy had failed. In all instances, extensive arteriographic studies had been carried out previously in order to locate the exact site or sites of occlusion. The obliterated segment of artery in each case was completely cleared of all adipose tissue and opened longitudinally for a distance of 4-6 cm. When the thrombus was exposed, a plane of cleavage was produced between the external elastic limiting layer and the media. Then the necrosed media, the internal elastic limiting layer, the intima and the thrombus were removed, leaving the external elastic limiting layer and the adventitia. The endarteriectomy was completed above and below by cutting through the inner arterial coats in a healthy zone and then the vessel was closed. During the entire operation the arterial bed was frequently irrigated by a heparin soln. Postoperatively heparin was given intraven. for the first 3 or 4 days. In approx. half the cases complete relief of symptoms occurred. There were no signs to indicate that removing the various layers of the vessel weakened the wall to a dangerous degree, provided the external elastic limiting layer was in a healthy condition.