To demonstrate the utility of aortoiliac endarterectomy as an effective open surgical treatment option in the management of severe, calcific, aortoiliac occlusive disease.

The patient is a 75 year old diabetic female who was a former smoker presenting with progressive pain with walking a few steps and who had recently developed foot discoloration and resting ischemic symptoms. Physical examination revealed no femoral or distal pulses and lower extremity non-invasive studies suggested severe lower extremity occlusive disease. CT angiography confirmed severe, calcific aortoiliac occlusive disease extending from the level of the renal arteries to the common iliac artery bifurcations. An endovascular approach was thought to be inadvisable because of arterial access issues, diminutive aortoiliac vessels and circumferential aortic calcification.

After preoperative medical evaluation, an aortoiliac endarterectomy was performed through a midline abdominal incision. Division of the renal vein and temporary suprarenal aortic clamping were required. The arteriotomy was closed with a Dacron patch and the details are demonstrated in the video presentation. The patient recovered bilateral dorsalis pedis pulses and normal lower extremity noninvasive studies postoperatively. She was discharged on the eighth postoperative day with normal renal function.

Aortoiliac endarterectomy has a useful role in properly selected patients with severe, calcific aortoiliac occlusive disease.