Extraperitoneal aortoiliac disobliteration with plaque cracker.

Disobliteration of the aorta and iliac arteries through an extraperitoneal approach is described. An intimal guillotine (plaque cracker) is used to transect the intima of the unopened vessel. The intima is then milked down to a transverse arteriotomy in the left common iliac artery, through which all of the discarded intima is removed. Since the intima is dissected free before opening the vessels, blood loss is minimal. The procedure is rapid and requires only an average of 19 minutes of aortic cross clamping. Our operative mortality was 4.2 per cent and the long-term patency rate 75 per cent.