Endovascular aortic aneurysm repair: alternative strategies

Wisselink, W. [Promotor]Vos, A.W.F. [Copromotor

Robot-assisted laparoscopic aortobifemoral bypass for aortoiliac occlusive disease: early clinical experience

AbstractBackgroundRobotic technology may facilitate laparoscopic aortic reconstruction. We present our early clinical experience with laparoscopic aortobifemoral bypass, aided by two different robotic surgical systems.MethodsBetween February 2002 and April 2004, we performed eight robot-assisted laparoscopic aorto-bifemoral bypasses for aortoiliac occlusive disease. All patients were male; median age was 55 years (range: 36–64). Dissection was performed laparoscopically and the robotic system was used to construct the aortic anastomosis.ResultsA robot-assisted anastomosis was successfully performed in seven patients. Median operative time was 405min (range: 260–589), with a median clamp-time of 111min (range: 85–205). Median blood loss was 900ml (range: 200–5800). Median anastomosis time was 74min (range 40–110). In two patients conversion was necessary, one due to bleeding of an earlier clipped lumbar artery after completion of the anastomosis, the other because of difficulties with the laparoscopic exposure of the aorta. On post-operative day 3 one patient died unexpectedly as a result of a massive myocardial infarction. Median hospital stay was 7.5 days (range: 3–57).ConclusionOur initial experience with robotic assisted laparoscopic surgery (RALS) shows it is a feasible technique for aortoiliac bypass surgery. However, laparoscopic aortoiliac surgery demands considerable experience and operative times need to be reduced before this technique can be widely implemented

Mid-term survival and costs of treatment of patients with descending thoracic aortic aneurysms; endovascular vs. open repair: a case-control study

AbstractObjectivesTo evaluate the results of open surgery or endovascular stent graft repair of descending thoracic aortic aneurysm (TAA).Design, materials and methodsThis is a retrospective multicenter study of 95 patients undergoing TAA repair (42 stent grafts, 53 open repair). The median age was 67 years. Post-operative complications, mid-term survival and costs were assessed. The results were pooled with data in the literature.ResultsAfter a mean follow up of 26 months (open group) and 15 months (endovascular group) survival was similar for patients treated by either repair method. Post-operative pneumonia was more in the open group (p<0.02). The hospital costs of open treatment were 40% more than that of the endovascular procedure. Combining the present results with pooled data from the literature the peri-operative mortality and paraplegia rate was less in the endovascular group (p<0.05).ConclusionsThese retrospective data suggest that endografting of descending thoracic aneurysms can be performed with less peri-operative morbidity, at lower hospital costs, but with equal mid-term life expectancy, compared with open grafting