Control of Backbleeding During Aorto-iliac Endarterectomy

TO ACHIEVE a dry operative field during aorto-iliac endarterectomy, it is necessary to control the back-bleeding from two or three pairs of lumbar arteries as well as from the inferior mesenteric artery and the middle sacral artery (when present). Heavy silk ligatures or bulldog clamps are usually used for temporary occlusion. Although these achieve their purpose, they can be cumbersome and fill the operative field with unnecessary instruments. Recently, for this purpose, we have used removable Mayfield clips used in neurosurgery. They performed extremely well. They are small, easy to apply, and easy to remove. Although a clip applicator can be used with them, a large hemostat will work as well. They do not interfere with other clamps in the field and can be removed without damage to the vessel (Fig 1 and 2). They have also been satisfactorily used in the femoral, popliteal, carotid, and thoracic areas.