Total Laparoscopic Aortofemoral Bypass as a Routine Procedure for the Treatment of Aortoiliac Occlusive Disease

Judith C. Lin, MD, Ralf Kolvenbach, MD, PhD; Elisabeth Schwierz MD; Sergej Wassiljew MD

Disclosures

Vascular. 2005;13(2):80-83. 

In This Article

Discussion

Patients with atherosclerotic, AIOD are at high risk of postoperative complications, and a minimally invasive procedure may favorably affect their postoperative recovery. The majority of the 68 patients (75%) in our series had undergone interventional procedures prior to their surgical intervention. Our preference is to treat the occlusive lesions via endovascular means and to reserve surgical intervention for those who have failed endovascular treatment. Laparoscopic vascular surgery is another minimally invasive, feasible, safe, and effective technique for the treatment of AIOD and aneurysms.[12–15] Most of our patients stayed less than 1 day in the intensive care unit.

All operations were performed by three different surgeons. When operating and cross-clamp times were analyzed according to the individual experience of the operating surgeon, the cross-clamp time was significantly surgeon dependent. A reduction in total operative time can be accomplished only when the entire operative team has sufficient experience with laparoscopic aortic procedures. In this series of patients, the mean BMI was 28 ± 1 kg/m2; however, obesity was not a contraindication for laparoscopic aortoiliac surgery. It appears that obese patients can benefit particularly from a minimal invasive approach. Postoperative hospital stay was correlated with the age of the patient.[16] The majority of patients younger than 60 years could be discharged on the third or fourth postoperative day. Older patients, especially those in their eighties, were kept in the hospital longer, mainly for nonmedical or social reasons.

In our experience, an end-to-end anastomosis was more difficult simply because of the aortic pathology. This would require adjunctive procedures, such as a thromboendarterectomy and polytetrafluoroethylene graft reinforcement of the suture line. A major advantage of the transperitoneal, left retrocolic access is the position of the graft on the left lateral aspect of the aorta, which prevents the development of a fistula between the duodenum and the prosthesis. With this kind of access, peritoneal covering of the graft does not cause problems, as opposed to a transperitoneal approach, especially in very thin patients.

Although there is a learning curve, a laparoscopic approach can be offered routinely to most patients who require surgical intervention for AIOD. Operative times, as well as aortic cross-clamp time, were only slightly longer than for open surgery. We now have the operative technique and the instrumentation to progress to total laparoscopic aortic procedures as a routine operation for the treatment of long-segment AIOD.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....