A comparative cohort study of totally laparoscopic and open aortobifemoral bypass for the treatment of advanced atherosclerosis

Abstract

BackgroundTotally laparoscopic aortobifemoral bypass (LABF) procedure has been shown to be feasible for the treatment of advanced aortoiliac occlusive disease (AIOD). This study compares the LABF with the open aortobifemoral bypass (OABF) operation.MethodsIn this prospective comparative cohort study, 50 consecutive patients with type D atherosclerotic lesions in the aortoiliac segment were treated with an LABF operation. The group was compared with 30 patients who were operated on with the OABF procedure for the same disease and time period. We had an explanatory strategy, and our research hypothesis was to compare the two surgical procedures based on a composite event (all-cause mortality, graft occlusion, and systemic morbidity). Stratification analysis was performed by using the Mantel–Haenszel method with the patient–time model. Cox multivariate regression method was used to adjust for confounding effect after considering the proportional hazard assumption. Cox proportional cause-specific hazard regression model was used for competing risk endpoint.ResultsThere was a higher frequency of comorbidity in the OABF group. A significant reduction of composite event, 82% (hazard ratio 0.18; 95% CI 0.08–0.42, P=0.0001) was found in the LABF group when compared with OABF group, during a median follow-up time period of 4.12 years (range from 1 day to 9.32 years). In addition, less operative bleeding and shorter length of hospital stay were observed in the LABF group when compared with the OABF group. All components of the composite event showed the same positive effect in favor of LABF procedure.ConclusionLABF for the treatment of AIOD, Trans-Atlantic Inter-Society Consensus II type D lesions, seems to result in a less composite event when compared with the OABF procedure. To conclude, our results need to be replicated by a randomized clinical trial.

Perioperative humoral stress response to laparoscopic versus open aortobifemoral bypass surgery

“…However, in patients with severe aortoiliac occlusive disease the changes in the hemodynamics have been shown to be less prominent probably due to a gradual development of collateral vessels secondary to AIOD [14]. Laparoscopic aortic surgery was introduced at Oslo University Hospital, Aker, in 2005 and after successfully conducting a prospective comparative cohort study during the earlier experience, a randomized multicentre trial, Norwegian Laparoscopic Aortic Surgery Trial (NLAST) is being performed [16].…”

Patient-perceived health-related quality of life before and after laparoscopic aortobifemoral bypass

“…However, in patients with advanced atherosclerotic disease, it is sometimes necessary to perform additional procedures, for example, thromboendarterectomy of the groin arteries or even infrainguinal bypass, to ensure postoperative graft patency. We have previously, in a comparative cohort study design in the same patient population, found a significant relative reduction of the composite events (all-cause mortality, graft occlusion and systemic morbidity) in patients with LABFB as compared to open ABFB, during a median follow-up time period of 4.12 years 1. This may be due to the less-invasive nature of the LABFB procedure.…”

Totally laparoscopic aortobifemoral bypass surgery in the treatment of aortoiliac occlusive disease or abdominal aortic aneurysms – a systematic review and critical appraisal of literature

“…A median blood loss of 400 mL72 was reported as the lowest for the laparoscopic group, with a median of 725 mL5 being the most substantial amount of hemorrhage occurring. In the open group, the blood loss ranged from 9825 to 1010 mL 4.…”

“…One study did not report this outcome at all 70. Two studies found the difference between the two groups to be statistically significant,4,72 two did not report p -values,69,70 and in one paper, the difference did not reach statistical significance 5…”

“… Notes: aAll comparative studies are non-robotic.bThis study reports composite endpoints.cThis study reports total mortality and morbidity at the end of the study and could not be included in the comparison of mortality between the two groups.dThe study reports number of systemic complications and graft thrombosis altogether at the end of the study.eNo major complications in either group, only minor.fNote that the study by Kazmi et al72 could not be included in the calculation. Abbreviations: LABF, laparoscopic aortobifemoral bypass; OABF, open aortobifemoral bypass; NR, not reported.…”