From the Guidelines
Longitudinal arteriotomy is recommended in vascular surgery when dealing with complex procedures such as thoracoabdominal aneurysms, particularly if end-organ ischemia or significant stenosis from atherosclerotic visceral artery disease is present, as it allows for maximum exposure and additional revascularization procedures 1.
Key Considerations
- The decision to perform a longitudinal arteriotomy should be based on the specific needs of the patient, including the size and location of the aneurysm, as well as the presence of any connective tissue disorders or significant comorbid disease.
- For patients with thoracoabdominal aneurysms, elective surgery is recommended if the aortic diameter exceeds 6.0 cm, or less if a connective tissue disorder such as Marfan or Loeys-Dietz syndrome is present 1.
- Longitudinal arteriotomy provides excellent visualization of the vessel's interior, allowing for thorough exploration and treatment of the diseased segment.
Indications and Techniques
- This technique is specifically indicated for procedures requiring maximum exposure of the arterial lumen, such as removal of extensive atherosclerotic plaque or extraction of thrombus.
- The surgeon should make the incision along the anterior surface of the artery, avoiding branch points, and extend it to fully expose the diseased segment.
- Primary closure with fine monofilament sutures or patch angioplasty using autologous vein, bovine pericardium, or synthetic materials may be used, depending on the size of the artery and the specific needs of the patient.
Benefits and Risks
- The longitudinal approach allows for better visualization and access to the entire diseased segment, making it preferred over transverse arteriotomy for complex procedures.
- However, it may result in more narrowing upon closure and requires more extensive dissection of the artery, highlighting the need for careful consideration and planning in each individual case 1.
From the Research
Longitudinal Arteriotomy in Vascular Surgery
- The decision to perform a longitudinal arteriotomy in vascular surgery depends on various factors, including the type of procedure, vessel size, and patient characteristics 2, 3, 4.
- A study published in 1990 compared transverse and longitudinal arteriotomies in end-to-side microvascular anastomoses for small vessels (1-2 mm) and found that transverse arteriotomy is preferable for technical reasons 2.
- However, a more recent study published in 2020 found that longitudinal slit arteriotomy end-to-side anastomosis is a viable option for limb-threatening defects in high-risk patients, with a high overall flap success rate and limb salvage rate 4.
- Another study published in 2016 reviewed various arteriotomy methods, including single-cut or slit arteriotomy (longitudinal and transverse) and excision arteriotomy, and found that microsurgeons have multiple arteriotomy methods at their disposal 3.
- The choice of arteriotomy technique may also depend on the specific vascular disease being treated, such as atherosclerotic vascular disease, which requires a comprehensive program of guideline-directed medical therapy and surgical revascularization in selected patients 5, 6.
Indications for Longitudinal Arteriotomy
- Longitudinal arteriotomy may be indicated for patients with limb-threatening defects, particularly those with diseased recipient arteries 4.
- It may also be considered for patients with atherosclerotic vascular disease who require surgical revascularization, although the choice of arteriotomy technique will depend on various factors, including vessel size and patient characteristics 5, 6.
- In general, the decision to perform a longitudinal arteriotomy should be made on a case-by-case basis, taking into account the specific needs and characteristics of each patient 2, 3, 4.