Transaortic Renal and Visceral Endarterectomy

Abstract

In 1946 Dos Santos’ performed the first endarterectomy serendipitously during a femoral thrombectomy. When the pathology report described a fragment of the inner arterial wall, he immediately recognized the significance of this procedure. Wylie et a1.2 pioneered the technique in the United States and performed the first renal and aortic endarterectomy in 1952. Transaortic endarterectomy evolved at the University of California, San Francisco, under Wylie and was later extended to the visceral arteries. This article describes the technique of transaortic renal and visceral endarterectomy. Aortic atherosclerosis is the most common cause of obstruction of the renal and visceral artery ostia; the resultant vascular bed ischemia leads to renovascular hypertension, ischemic nephropathy, and/or chronic visceral ischemia. As the aortic atherosclerotic process “overflows” into the orifices of the renal and visceral arteries, the abnormality is usually confined to the proximal 2 cm of the ve~se l .~ This distribution of disease makes it particularly suitable for transaortic endarterectomy. Successful endarterectomy must begin in the aorta and continue into the renal or visceral artery where the disease terminates in a predictably smooth, tapered end point or transition to a more normal intimal lining. A general principle of endarterectomy warrants emphasis; that is, the correct cleavage plane is