1. Introduction

2. Incision and Exposure

3. Heparinization and Clamping

a. Arteriotomy

b. Remove Bulk of Plaque

c. Check Proximal Flow

d. Check Proximal End Point

e. Check Profunda and Distal End Point

f. Check Branches

g. Check SFA and Define Distal End Point

h. Final Inspection

4. Endarterectomy

a. Hemostasis and Reversal of Heparin

5. Patch Placement

a. Pulse Volume Recording (PVR)

b. Doppler: Interrogate Distal Flow

c. Doppler: Interrogate Proximal Flow

6. Interrogation of Blood Flow

7. Hemostasis

8. Closure

9. Post-op Remarks

This case describes an 85-year-old gentleman with significant peripheral arterial disease and lifestyle-limiting claudication who had previously undergone an unsuccessful attempt at endovascular treatment of his significant right common femoral artery stenosis. At our institution, we proceeded with open surgical intervention and performed a right common femoral endarterectomy to remove his significant plaque burden. Postoperatively, the patient noted significant improvement in his right lower extremity claudication, and his postoperative pulse volume recordings show improved arterial inflow. This article provides background information regarding this particular patient’s case, as well as a detailed description of the steps of the surgical procedure itself.

Watch this full-length, narrated surgical video of a femoral endarterectomy performed by Dr. Anahita Dua at MGH on a patient with severe peripheral artery disease.

Massachusetts General Hospital