Videoendoscopic Thoracic Aorta-to-Femoral Artery Bypass in the Pig

Noel, Audra A.; Gloviczki, Péter; Young, Mary M; Karnicki, Krzysztof; Deschamps, Claude; Moir, Christopher R.

doi:10.1006/jsre.2000.5933

Cited by 5 publications

(6 citation statements)

References 21 publications

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“…5,6 In humans, the videoendoscopic technique was associated with a minithoracotomy to perform anastomosis with direct vision or to serve for inserting the side-biting clamp. 7,8 In 2003, we reported the first TVDTAFB with the clamping and the suturing performed without the adjunct of a thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

Totally videoendoscopic descending thoracic aorta-to-femoral artery bypass

Fukui

Paraskevas²,

Soury³

et al. 2010

Journal of Vascular Surgery

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Descending thoracic aorta to femoral artery bypass is an effective and safe procedure for the treatment of aortoiliac occlusive disease when an approach to the abdominal aorta is undesirable. The major limitation of this technique has resulted from the morbidity rate associated with thoracotomy in a relatively high-risk vascular surgery population. As a minimally invasive procedure, videoendoscopy has been shown to improve the patient postoperative course and comfort in the field of general and thoracic surgery. The same benefits could be expected from a videoendoscopic surgery involving the thoracic aorta. In 2003 we reported the first case of a totally videoendoscopic descending thoracic aorta-to-femoral artery bypass procedure. In this article we report our additional experience with and the modifications we have made to this technique.

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Section: Discussionmentioning

confidence: 99%

Totally videoendoscopic descending thoracic aorta-to-femoral artery bypass

Fukui

Paraskevas²,

Soury³

et al. 2010

Journal of Vascular Surgery

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“…Videoscopic aortic reconstruction can be performed as a totally laparoscopic technique or as a laparoscopic-assisted technique with handassisted or laparoscopic dissection, combined with open aortic suturing. Experimental studies [1][2][3][4][5] and initial clinical series, 1,6-10,13 done for aortoiliac aneurysmal or occlusive disease, confirm that aortic grafting can be completed successfully by using these techniques. Clinical studies suggest rapid recovery following minimally invasive aortic surgery, with less prolonged postoperative ileus, less postoperative pain, fewer fluid shifts, shorter hospitalization stay, and earlier return to normal activities compared to the traditional open approaches.…”

Section: Discussionmentioning

confidence: 99%

“…Mean aortic cross-clamp time in 8 successful cases was 4.3 ±2.9 minutes (range 2-11 minutes) and was significantly shorter than previously reported operative clamp time with use of videoscopic suturing technique to perform similar bypasses in 10 pigs (48.7 ±9.4 minutes, p < 0.0001, Figure 5). 5 Imperviousness at the anastomosis was good or excellent in 4 cases and fair in 4 cases, requiring the addition of a prolene stitch to achieve adequate surgical hemostasis. All grafts were patent at the end of the procedure.…”

Section: Study Groupmentioning

confidence: 97%

“…In the last decade, minimally invasive techniques emerged to reduce morbidity and convalescence period of open surgical procedures. Although most studies have been performed in animals, [1][2][3][4][5] several investigators have successfully completed laparoscopic and thoracoscopic bypasses in humans. 1,[7][8][9][10] Experimental studies report similar bursting strengths and leakage amounts between videoscopically sutured aortic anastomoses and conventional sutured anastomoses.…”

Section: Introductionmentioning

confidence: 99%

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Stapled Aortic Anastomoses: A Minimally Invasive, Feasible Alternative to Videoscopic Aortic Suturing?

Elkouri¹,

Noel²,

Gloviczki³

et al. 2004

Vasc Endovascular Surg

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Widespread applications of totally laparoscopic aortic reconstructions have been limited by the long cross-clamp time required to suture the aortic anastomosis despite improvement in instrumentation. The authors' hypothesis was that a "one-step anastomosis concept" using an intraluminal stapler would allow shorter cross-clamp time but similar patency and imperviousness as videoscopic suturing techniques. An intraluminal stapler (Endopath-ILS, Ethicon) with a modified anvil was used to perform videoscopic-assisted thoracic aorta-to-iliac artery bypass with a 21 mm by 8 mm polytetrafluoroethylene (PTFE) graft in 22 sheep through a minimally invasive approach using a 5 cm thoracotomy. The graft-to-iliac artery anastomoses were hand sutured through a flank incision. Twelve sheep were used to establish the technique and 10 subsequent animals constituted the study group. Aortic cross-clamp time, imperviousness, and need for additional sutures were recorded and compared to previously reported data using videoscopic suturing in pigs. Patency was assessed by comparing lower limb arterial pressures. Macroscopic and microscopic examinations of the anastomoses were performed at different time-points within the first 3 months. Videoscopic-assisted stapled anastomoses were also performed on atherosclerotic aortas of 3 human cadavers. Stapled anastomoses between the thoracic aorta and PTFE graft were completed in 8 of 10 animals. Two animals were euthanized after stapler failure and anastomotic bleeding. Sutures to strengthen the anastomosis had to be used in 4 cases. Mean aortic cross-clamp time in 8 successful cases was 4.3 +/-2.9 minutes (range 2-11 minutes) and was significantly shorter than clamp time of videoscopic suturing technique (48.7 +/-9.4 minutes, p < 0.0001). Imperviousness was good or excellent in 4 animals and fair in 4 animals. All anastomoses were patent at the end of the procedure. Examination of the anastomosis of the 2 failed interventions showed medial aortic tear surrounding the anastomosis in 1 case and misfired staples in the other. No graft occlusion was noted during follow-up ranging from 0 to 12 weeks. At the time of harvest, no bleeding was noted after epinephrine and volume infusion to increase mean arterial pressure to 200 mm Hg for 15 minutes. Macroscopic examination of the anastomoses revealed adequate healing with circumferential stapling of the prosthesis to the aortic wall and no stenosis or thrombus except in 1 false aneurysm (1/7, 14%). Surface electron microscopy showed cells coverage of the anastomosis surface. When applied on human cadaver thoracic and abdominal aorta with atherosclerotic changes, clamping times of less than 5 minutes were achieved. However, imperviousness tested with saline was poor. An automatic stapling device allows performance of a graft-to-aorta anastomosis through a minimally invasive approach with shorter clamping time than a videoscopic suturing technique. However, the current technique of aortic stapling is unreliable and further improvements are needed.

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“…The feasibility of totally videoendoscopic descending thoracic aorta to femoral artery bypass has been shown in several experimental studies. [6][7][8] In humans, McMillan and McCarthy 4 reported one case performed with videoendoscopy associated with a minimal incision. They exposed the aorta with a videoendoscopic technique and instrumentation.…”

Section: Discussionmentioning

confidence: 99%

Totally videoendoscopic descending thoracic aorta to femoral artery bypass

Fukui

Paraskevas

Soury

et al. 2003

Journal of Vascular Surgery

View full text Add to dashboard Cite

Descending thoracic aorta to femoral artery bypass is an effective and safe procedure for the treatment of aortoiliac occlusive disease when an approach to the abdominal aorta is undesirable. The major limitation of this technique has resulted from the morbidity rate associated with thoracotomy in a relatively high-risk vascular surgery population. As a minimally invasive procedure, videoendoscopy has been shown to improve the patient postoperative course and comfort in the field of general and thoracic surgery. The same benefits could be expected from a videoendoscopic surgery involving the thoracic aorta. We report what we think to be the first totally videoendoscopic descending thoracic aorta to femoral artery bypass.

show abstract

Videoendoscopic Thoracic Aorta-to-Femoral Artery Bypass in the Pig

Cited by 5 publications

References 21 publications

Totally videoendoscopic descending thoracic aorta-to-femoral artery bypass

Totally videoendoscopic descending thoracic aorta-to-femoral artery bypass

Stapled Aortic Anastomoses: A Minimally Invasive, Feasible Alternative to Videoscopic Aortic Suturing?

Totally videoendoscopic descending thoracic aorta to femoral artery bypass

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