From the Guidelines
The choice between longitudinal and transverse arteriotomy should be based on the clinical scenario and vessel characteristics, with longitudinal arteriotomies preferred for endarterectomy procedures and transverse arteriotomies for end-to-end anastomoses or minimal vessel narrowing. When deciding between longitudinal and transverse arteriotomy, several factors should be considered, including:
- Vessel diameter and extent of disease
- Need for patching or vessel exploration
- Specific procedure being performed, such as endarterectomy or anastomosis
- Vessel elasticity, with more elastic vessels like the aorta tolerating longitudinal incisions and less elastic vessels benefiting from transverse approaches. According to the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease 1, patch angioplasty can be beneficial for closure of the arteriotomy after carotid endarterectomy (CEA), which may influence the choice of arteriotomy. The guideline also notes that the technique of arterial repair after CEA depends mainly on the length of the arteriotomy, with primary closure being faster but having higher incidences of residual and recurrent stenosis, and patch closure providing visual confirmation of complete plaque removal but requiring more time 1. In terms of patient characteristics, older patients (over 80 years) may have higher risks of complications after CEA, while women may face higher operative risks than men 1. Ultimately, the decision between longitudinal and transverse arteriotomy should be made on a case-by-case basis, taking into account the individual patient's anatomy, disease extent, and procedural requirements, as well as the surgeon's expertise and experience. Key considerations include:
- The need for adequate exposure and visualization of the vessel lumen
- The potential for vessel narrowing or stenosis after closure
- The risk of complications, such as embolism or mechanical injury, associated with shunting or patching
- The importance of preserving vessel wall integrity and elasticity.
From the Research
Longitudinal vs Transverse Arteriotomy
- The choice between longitudinal and transverse arteriotomy depends on various factors, including the size of the vessel and the specific surgical procedure being performed 2, 3.
- For small end-to-side vascular anastomoses, transverse arteriotomy is recommended due to its simplicity and ease of suturing 2.
- In cases where the vessel is small (</=4 mm), patch closure may be preferred to avoid restenosis, regardless of the type of arteriotomy used 4.
- Longitudinal arteriotomy may result in greater stenosis than transverse arteriotomy, especially in larger vessels 3.
- The technique of arteriotomy can be classified into single-cut or slit arteriotomy (longitudinal and transverse) or excision arteriotomy, with various methods available for each approach 5.
Indications for Longitudinal Arteriotomy
- Specific indications for longitudinal arteriotomy may include cases where a patch closure is not feasible or desirable 4, 6.
- Longitudinal arteriotomy may be preferred in certain situations, such as when a simple closure of the arteriotomy is not possible due to the size or location of the vessel 6.