Mathematical modeling of an optimal mini-access for reconstruction of arteries of the aortofemoral segment

Abstract

Aim. To determine the optimal size and location of the mini-laparotomic access for the reconstruction of arteries of the aortofemoral segment. Methods. The method of mathematical modeling was used. The parameters of the mini-access were calculated depending on the sex of the patient, as well as for a variety of clinical situations (operations for occlusive disease, for abdominal aortic aneurysm, including the propagation of the aneurysmal dilatation to the iliac arteries). Topography of the aorta and iliac arteries was determined on the basis of computer tomograms of 155 patients (61 of them with an aneurysm of the infrarenal aorta). Results. It was established that for the purpose of creation of an adequate access an incision of 6.8-7.0 cm in length at the level of the umbilicus and above is sufficient during surgery for occlusive disease. No significant gender differences were found. During aortic aneurysm the required length of the mini-laparotomic access is significantly increased up to 7.6 cm (p=0.003), and in cases of propagation of the aneurysmal dilatation on to the common iliac arteries - up to 8.5 cm (p=0.001). In the latter case its location also changes: approximately half of the length of the access incision is located below the umbilicus. Conclusion. Mathematical modeling of the optimal mini-access makes it possible to optimize the use of mini-laparotomy in various clinical situations.

Mini-Access in the Abdominal Aorta Surgery

“…в исследовании а.в. максимова с соавт., проведенном на основе анализа компьютерных томограмм 155 больных, в том числе 61 с аневризмой инфраренального отдела аорты, была рассчитана средняя длина мини-лапаротомного доступа, которая составила 7,6 см у пациентов с аневризмами аорты и 8,5 см при распространении аневризмы на подвздошные артерии [48]. при этом, по мнению автора, в первом случае кожный разрез должен располагаться выше и на уровне пупка, а в случае распространения аневризматического расширения на общие подвздошные артерии примерно половина длины доступа должна локализоваться ниже пупка.…”