Lachat M

Mayer D

PECORARO, Felice

Rancic Z

Veith FJ

Archivio istituzionale della ricerca - Università di Palermo

the use of an open vascular simulation course to teachvascular surgical skills to junior residents.Author Disclosures: E. Arous: Nothing to disclose; D.Baril: Nothing to disclose;L. Cardin: Nothing to disclose;B. S. Cutler: Nothing to disclose; M. H. Eslami: Nothingto disclose; A. Larkin: Nothing to disclose; L. M.Messina: Nothing to disclose; W. P. Robinson: Nothingto disclose; A. Schanzer: Nothing to disclose; R. Whitten:Nothing to disclose.VS5.Video PresentationSutureless Clampless Telescoping Method for Aorticand Arterial Anastomoses Using an Endograft Connec-torMario Lachat2, Dieter Mayer2, Felice Pecoraro2, ZoronRancic2, Frank J. Veith1. 1Surgery, New York Universityand The Cleveland Clinic, Bronx, NY; 2Clinic for Cardio-vascular Surgery, University Hospital Zurich, Zurich, Swit-zerlandBackground: We have developed a method to exposeonly a limited portion of an artery or the aorta, puncture it,insert a guide wire, and (using a sheath, balloon and en-dograft connector) make an arteriotomy and anastomose aprosthetic graft to it to restore or maintain flow. Circum-ferential dissection and clamping of the artery/aorta is notrequired and ischemia is minimized.Technical Description: This video will show in modelshow this technique is performed to construct 1) The aorticanastomosis for aorto-bifemoral bypasses, 2) Bypasses to therenal, visceral and iliac arteries and 3) Bypasses to the supra-aortic branches.Representative examples of this techniquewillalso be shown in patients undergoing these procedures. Thismethod has been used to perform functionally end-to-endanastomoses to the aorta or any of its major branches in 161patients (288 vessels). Anastomotic patency without steno-sis has been observed up to 6 years in 91% of theseanastomoses.Discussion: This technique is particularly advanta-geous when vascular dissection and exposure is difficult andcalcification precludes arterial clamping and suturing. In-terruption of blood flow is limited to less than 4 minutes.CT and contrast arteriography demonstrating adequacy ofthese anastomoses for more than 5 years will be shown.Conclusions: This technique, which uses endovasculartools, provides a better way for performing open arterialand aortic anastomoses. It should be particularly useful incircumstances in which a standard suture anastomosis maybe difficult, impossible or associated with unacceptable endorgan ischemia.Author Disclosures: M. Lachat: Nothing to disclose; D.Mayer: Nothing to disclose; F. Pecoraro: Nothing todisclose; Z. Rancic: Nothing to disclose; F. J. Veith:Nothing to disclose.SS26.Population-Based Analysis of Inpatient Vascular Pro-cedures: Predicting Future Workload and Implicationsfor TrainingJeffrey Jim, Pamela L. Owens, Luis A. Sanchez, Brian G.Rubin. Washington University School of Medicine, St.Louis, MOObjectives: To analyze the trend in inpatient vascularprocedures in the United States over the past decade andpredict the future demand for vascular surgeons.Methods: The Healthcare Cost and Utilization Proj-ect Nationwide Inpatient Sample was queried for allvascular procedures performed on adult (age18) pa-tients between 1997 and 2008. Using population esti-mates from the United States Census Bureau, the percapita rates of inpatient procedures were calculated forage-specific groups (18-64 years, 65-84 years, and 85years). The change in per capita rates over the pastdecade along with population forecasts were used topredict future workload.Results: There was a net increase of 22% from971,046 inpatient vascular procedures for all adults in1997 to 1,188,332 in 2008. During the same timeperiod, the adult population increased by 16% from 198to 230 million. The age-stratified per capita rates ofprocedures were: 16.8% for age 18-64; 2.8% for age65-84; and 17.4% for age85. This resulted in a netincrease of 4% (490 to 515 procedures per 100,000people) in the per capita rate for all adults. Based on theassumption that trends in age-specific rates remain con-stant, there is a predicted inpatient workload increase(compared to 2008) of 18% by 2015, 34% by 2020 and72% by 2030. The vascular workload is predicted tomore than double by the year 2040.Conclusions: Despite a conservative approach of uti-lizing a population-based analysis of only inpatient proce-dure volume, there is a dramatic increase in the predictedvascular workload for the future. Training programs willneed to adapt to ensure an adequate number of fellowshiptrained vascular surgeons is available to provide qualityvascular care in the future.JOURNAL OF VASCULAR SURGERYVolume 53, Number 17S Abstracts 29S

Sutureless Clampless Telescoping Method for Aortic and Arterial Anastomoses Using an Endograft Connector

https://iris.unipa.it/retrieve/handle/10447/99942/133716/14_2011%20VP%20Sutureless%20Clampless.%20JVS.pdf

Sutureless Clampless Telescoping Method for Aortic and Arterial Anastomoses Using an Endograft Connector

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