Aortoiliac TEA (thromboendarterectomy) in bilateral stage IIb peripheral arterial (occlusive) disease (PAD) - Vascular surgery

Perform median laparotomy from xiphoid down to symphysis, carrying the incision to the left of the umbilicus.

Tips:

1. Maintain adequate distance from the umbilicus and do not incise the skin tangentially as this runs the risk of wound edge necrosis.

2. If the incisdion damages the cartilage of the xiphoid, it may trigger heterotopic ossification in the scar. Therefore start the incision somewhat lateral to the xiphoid.

Open the retroperitoneum, while sparing the inferior mesenteric artery (IMA), somewhat to the right of the palpable aorta and the right iliac axis. After sweeping the small bowel loops to the right, coagulate step by step and in advance any exposed small vessels to reduce unnecessary bleeding. After freeing the duodenojejunal flexure, locate and identify the crossing left renal vein as the upper boundary.