A total laparoscopic technique for endovascular thoracic stent graft deployment

• Published in: Journal of vascular surgery 2010-02, Vol.51 (2), p.504-508
• Main Authors: Yoshida, Ricardo, MD, Kolvenbach, Ralf R., MD, Ye, Zhidong, MD, Yoshida, Winston, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anastomosis, Surgical; Ankle - blood supply; Aortic Aneurysm, Thoracic - complications; Aortic Aneurysm, Thoracic - physiopathology; Aortic Aneurysm, Thoracic - surgery; Arterial Occlusive Diseases - complications; Arterial Occlusive Diseases - physiopathology; Arterial Occlusive Diseases - surgery; Biological and medical sciences; Blood Pressure; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - methods; Brachial Artery - physiopathology; Calcinosis - complications; Calcinosis - physiopathology; Calcinosis - surgery; Constriction, Pathologic; Diseases of the cardiovascular system; Female; Femoral Artery - surgery; Humans; Iliac Artery - physiopathology; Iliac Artery - surgery; Laparoscopy; Male; Medical sciences; Middle Aged; Polyethylene Terephthalates; Prosthesis Design; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Suture Techniques; Time Factors; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Video-Assisted Surgery
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2009.06.060

Background Limitations of endovascular thoracic aneurym treatment include small, tortuous, or severely calcified iliac arteries. We present our experience with a total laparoscopic access to deploy thoracic endografts. Methods A total laparoscopic left retrocolic approach was used in all cases. A Dacron conduit was laparoscopically sutured to either the iliac artery or to the aorta directly. The endograft was inserted through this conduit. After graft deployment, the Dacron prosthesis was tunneled to the groin and anastomosed with the femoral artery. Results The laparoscopic procedure could successfully be performed in 11 patients. In six cases, the aorta was used as an access and in five patients, the iliac arteries were preferred. In one of these cases, the right iliac artery was used for deployment of the endograft. After successful aorto- or ileo-femoral bypass grafting, all patients had an improvement of their ankle brachial index postoperatively. The mean operative time was almost four hours, including laparoscopy, laparoscopic anastomosis, endograft deployment, and femoral artery anastomosis or profundaplasty. Conclusion Totally laparoscopic assisted graft implantation in aorta or iliac arteries provides a safe and effective access for the endovascular delivery system. However, further evaluation and long follow-up are necessary to ensure the potential advantages of this technique. It is a less invasive option to overcome access-related problems with thoracic endograft deployment, giving the patient the advantage of a totally minimal invasive procedure.