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Updated: Aug 25, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Endarterectomy and shunt: alternatives or in tandem?
I A Andrievskikh1, A V Vazhenin, A V Kuklin
1Centre for Vascular Surgery, Regional Hospital No. 1, Chelyabinsk, Russia.
Insights
Combining endarterectomy with shunts or prosthetics shows promise for extensive arterial disease. This review assesses outcomes for aorta-iliac and femoro-popliteal-tibial conditions, offering insights for vascular surgeons.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Endarterectomy is effective for localized arterial occlusions.
- Extensive aorta-iliac and femoro-popliteal-tibial disease often treated with shunts or prosthetics.
- Combining endarterectomy with shunts/prosthetics is an alternative approach.
Purpose of the Study:
- To evaluate the outcomes of combined endarterectomy and shunt/prosthetic procedures.
- To assess the efficacy of this combined technique for extensive arterial disease.
- To analyze patient data from a specific surgical center.
Main Methods:
- Review of 567 patients operated on between 1987-1991.
- Inclusion of patients with aorta-iliac and femoro-popliteal-tibial disease.
- Diagnosis confirmed by ultrasonography, load tests, and angiography.
Main Results:
- The study included 541 patients with atherosclerosis and 26 with arterial inflammation.
- Patient age ranged from 32 to 78 years (551 men, 16 women).
- Severe ischemia (Fontain stage III-IV) was present in 341 patients; 213 had multi-site occlusions and multi-organ disease.
Conclusions:
- The combined technique offers a viable option for complex arterial disease.
- Further research is needed to fully establish the benefits of combined procedures.
- This study provides preliminary data on the combined approach for extensive vascular disease.
Abstract:
There is no doubt about the efficacy of endarterectomy in the instance of localized occlusions of the arterial tree. The procedure was first developed in 1946 and has been widely used. However, in the case of extensive, non-localized atheromatus disease of the aorta-iliac and the femoral-popliteal-tibial segments in the leg, the majority of vascular surgeons prefer the application of shunts or prosthetics. Nevertheless, there are proponents of extensive obliteration of the endothelium in these regions. There is also the possibility of combining both techniques. In order to assess the outcomes of the latter technique, we reviewed 567 patients who were operated on for aorta-iliac and for femero-popliteo-tibial disease at Chelyabinsk Centre for Vascular Surgery in Russia from 1987 to 1991. Five hundred forty-one of these suffered from atherosclerosis. The other 26 patients had non-specific inflammation of arterial system. The age distribution was 32 to 78 years; there were 551 men and 16 women. Ischemia in the degree of III to IV (according to the scale established by Fontain) was present in 341 patients. Multi-site occlusions and associated multi-organ disease affected 213 patients. Atheromatous disease was determined by ultrasonography, load tests and angiography.
