Options in the surgical management of aorto-iliac occlusive disease: a changing perspective

247

187

Section: Discussionmentioning

confidence: 99%

The management of severe aortoiliac occlusive disease: Endovascular therapy rivals open reconstruction

Kashyap

Pavkov

Bena

et al. 2008

247

187

“…2 Treatment options for AIOD include open repair (endarterectomy, bypass, and extra-anatomic bypass) and percutaneous endovascular interventions (angioplasty and/or stenting), with an ongoing debate regarding which cases benefit most from a given approach. [3][4][5][6] Patency rates related to angioplasty and stenting techniques vary, but approach 81% and 64% at 4 and 5 years, respectively. 7,8 Aorto-bifemoral bypass (AFB) is more invasive than endovascular techniques, but is still considered the more durable "gold standard" treatment, with a 5-year patency rate of 85%.…”

mentioning

confidence: 99%

Endovascular procedures for aorto-iliac occlusive disease are associated with superior short-term clinical and economic outcomes compared with open surgery in the inpatient population

Indes

Mandawat

Tuggle

et al. 2010

“…14 Multimorbid patients suffering from pulmonary and renal disorders or with other contraindications for endovascular therapy should be considered for treatment through the minimally invasive approach as a better anatomic alternative to axillobifemoral bypass procedures that are known to be associated with lower long-term bypass patency rates than the aortobifemoral bypass. 15 The minimally invasive approach could be beneficial not only for older patients because of reduction of adjuvant postoperative therapy and shorter hospital stay, but also in younger candidates for open surgery because it offers a better preservation of the integrity of autonomic nerves.…”

Section: Discussionmentioning

confidence: 99%

A minimally invasive approach for aortobifemoral bypass procedure

Andrási¹,

Humbert

Dorner³

et al. 2011

Surgical aortobifemoral bypass procedure for aortoiliac occlusive disease remains the gold standard treatment despite rapidly expanding range of indications for endovascular repair. Besides several disadvantages such as dysparaesthesias, hernias, and unpleasant outcome, transperitoneal exposure of the aorta is also associated with operative autonomic nerve injury. In five male patients, infrarenal aorta was exposed through a small (8 cm) supraumbilical midline incision. Incision of the posterior peritoneum above the infrarenal aorta was limited to 3 cm. A 1 cm infraumbilical incision allowed transperitoneal placement of the distal aortic clamp outside of the operative field. Four centimeters transverse incisions were made over the femoral bifurcations and implantation of the aortobifemoral graft followed. Extubation was performed after an operating time of 200 to 150 minutes with 30 to 20 minutes aortic clamping time. Nonopioids or nonsteroidal anti-inflammatory drugs were intermittently administered during 12 hours of intermediate care unit monitoring. Oral alimentation started 6 hours and complete mobilization at 48 hours postoperatively. Hospital discharge followed on the fourth to tenth postoperative day. This minimally invasive technique allows a precise and controlled open performance of all vascular anastomoses minimizing intraoperative and postoperative complications and significantly decreasing patient discomfort related to standard abdominal surgery.