Aortic Biopsy Techniques

Comprehensive Surgical Guide to Arterial Biopsy Approaches

Professor Atef Allam • Surgical Techniques • Risk Assessment

1. Aortic Biopsy

⚠️ High-Risk Challenges:

  • High-risk location: Full-thickness biopsy risks aortic rupture/dissection
  • Usually diagnosed via imaging (CTA/MRI) or resected specimens

Biopsy Approaches:

Method When Used Pros/Cons
Surgical (Open) During aortic aneurysm repair Gold standard (full-thickness sample)
Endovascular Experimental (catheter-based) Limited tissue, high fragmentation risk
Post-mortem Autopsy cases Definitive but not useful for treatment

✅ Recommendation:

  • Avoid biopsy unless surgically resecting (e.g., aortic replacement for aneurysm)
  • Intraoperative frozen section can guide repair strategy

2. Carotid Artery Biopsy

⚠️ Critical Vessel Challenges:

  • Stroke risk (embolism, dissection)
  • Critical vessel: Usually managed based on imaging (CTA/MRA)
Method When Used Pros/Cons
Open Surgical If carotid resection needed (e.g., aneurysm) Best sample, but high-risk
Endovascular Rare (high embolism risk) Small, fragmented tissue
Ultrasound-guided core needle Experimental (case reports) Less invasive but unreliable

✅ Recommendation:

  • Biopsy only if surgery is already planned (e.g., carotid endarterectomy)
  • Non-invasive imaging (MRI/MRA) preferred for diagnosis

Key Clinical Takeaways

  • ✅ Aorta/Carotid/Coronary: Biopsy too risky—use imaging
  • ✅ Renal/Popliteal: Biopsy only if surgery is needed
  • ✅ Mesenteric/Iliac: Biopsy rare, only during resection
  • ✅ Gold standard: Full-thickness surgical biopsy when feasible