New development for aorto bifemoral bypass – a clampless and sutureless endovascular and laparoscopic technique

Abstract

The classic procedure for aortobifemoral bypass is open surgery. Laparoscopy has been accepted by several authors as a minimal invasive alternative for aortoiliac occlusive disease. The totally retroperitoneal laparoscopic procedure has been described as an alternative to the transperitoneal approach. Whatever the approach, the aortoprosthetic anastomosis is a major difficulty making those techniques unpopular despite obvious advantages for the patients. We report a clampless and sutureless approach for the proximal anastomosis of a totally retroperitoneal laparoscopic aortobifemoral bypass using an EndoVascular REtroperitoneoScopic Technique (EVREST). This approach was proposed to a 56-year-old man with severe aortoiliac occlusive disease. There was no indication for endovascular re-vascularization. The patient was placed in a 30 degrees right lateral decubitus position. The dissection of the retroperitoneal space was performed and the infrarenal aorta was exposed. A bifurcated graft was inserted into the retroperitoneal space. Under videoscopic control the prosthetic limbs were brought to the groins. The main body of the graft was connected on the left side of the aorta by an intra and extra aortic covered stent-graft. This connection was performed without the use of an aortic clamp and without suture. The femoral anastomoses were performed by classic open surgery.

Preliminary Results from a Prospective Study of Laparoscopic Aortobifemoral Bypass Using a Clampless and Sutureless Aortic Anastomotic Technique

“…The present authors decided to apply this technique to total retroperitoneal laparoscopic aortobifemoral bypass. 12 Patients were selected based on their clinical stage (Fontaine classification) and on computed tomographic angiography. Inclusion criteria were Fontaine classification from stage II b (claudication <100 m) to IV (tissue loss), and aorto-iliac TASC D lesions with at least 4 cm of patent aorta beneath the renal arteries.…”

“…This technique has been described in a previous study. 12 To perform EVREST, each patient was positioned, under general anesthesia, in a 30 right lateral decubitus position. The operator, first assistant, and scrub nurse were on the left side of the patient.…”

Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

“…In 2008, Lachat et al 12 introduced the Viabahn Open Revascularization TEChnique (VORTEC), in which a stent graft is used to form a sutureless anastomosis in renal revascularization surgery. Since then, several authors (Bonvini et al, 13 Segers et al, 14,15 Donas et al, 16 Papadimitriou et al 17 ) have attempted to use this technique in aortic surgery. According to this technique, the aorta is punctured and a guidewire is positioned in the aorta.…”

“…C, Part of the sequence of the steps of the sutureless anastomosis with the anastomotic stenting technique. 14 Staplers. Since their invention, surgical staplers have been routinely used in pulmonary and gastrointestinal procedures.…”

“…A total of 41 studies 10,11,13,14,[16][17][18][19] were identified that reported outcomes for the use of AADs during surgery for thoracic and abdominal aortic reconstruction (Supplementary Tables I and II, online only). The meta-analysis included 27 studies with 50 cohorts, incorporating 1260 patients (Supplementary Table I, online only).…”