As Dr. Holec replied, the surgeon does have the final say; having said
this , I would agree with the advice re:caution in being to agressive with
re-exploration of a endart. with just an elevated  peak systolic vel.,esp. if
its less than 200cm/sec. One should  look for a visual defect 3-4mm plus,
  along with a focal velocity shift. Remember a hemodynamically
significant stenosis consist of a focal velocity shift and post stenotic
turbulance. Contrast this with a velocity shift but with no turbulance is
most likely due to a non-axial jet,tortuosity,or a smaller vessel
diameter(non-patched vessel). Spasm can also be entertained if there is
a long segment  of velocity shifts  noted, which can be changed by
putting papavorine  on the vessel rescanning to varify the normalization
of the velocity waveforms.
     One should scan in several planes especially transverse to r/o
artifacts,and to get a better sense of a defects total  lumen involvement

               Good luck to all doing intaop u/s.  Mike.