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REVISIONE
DELLA LETTERATURA INTERNAZIONALE
J
Vasc Surg. 2002 Apr;35(4):654-60. Minimally
invasive vascular surgery for repair of infrarenal abdominal aortic
aneurysm with iliac involvement. Matsumoto
M, Hata T, Tsushima Y, Hamanaka S, Yoshitaka H, Shinoura S, Sakakibara
N. Department
of Cardiovascular Surgery, Cardiovascular Center, Sakakibara Hospital,
Okayama, Japan. vivaldi@fa2.so-net.net.jp METHODS:
Twenty patients with AAA with iliac involvement underwent treatment with
bifurcated graft replacement with the MIVS technique. The procedure was
performed via minilaparotomy, with the incision length determined
according to the extent of the AAA obtained with ultrasound scanning and
with the small intestine confined completely within the abdominal cavity.
The proximal and distal operating fields were obtained with changing the
patient position and arranging for the abdominal incision to be
retracted cephalad and caudad. Perioperative courses in these 20
patients (the MIVS group) were analyzed in comparison with 14 patients
who underwent conventional open repair, which was performed through the
full midline laparotomy with the intestine simply covered with moistened
towels (the conventional group). RESULTS:
The MIVS technique for AAA repair was performed with a mean abdominal
incision length of 8.4 cm and a range from 6.5 to 11.2 cm. The patients
in the MIVS group showed earlier resumption of oral intake and
ambulation in comparison with those patients in the conventional group (liquid
diet: 1.1 +/- 0.3 days versus 2.9 +/- 1.4 days; P <.01; solid
diet: 2.0 +/- 0.2 days versus 3.9 +/- 1.4 days; P <.01; ambulation:
2.1 +/- 0.8 days versus 4.3 +/- 2.3 days; P <.01), with comparable
mortality and morbidity rates. Accordingly, the patients in the MIVS
group were discharged earlier (20.7 +/- 6.3 days versus 33.9 +/- 12.6
days; P <.01), and total hospitalization charges were significantly
decreased (2,232,791 +/- 200,747 Japanese yen versus 2,640,441 +/-
243,889 Japanese yen; P <.01). CONCLUSION:
The MIVS technique allowed earlier postoperative recovery with
comparable morbidity and mortality rates with the conventional technique
and, therefore, saved hospital stay length and total hospitalization
charges. Thus, the MIVS technique is considered as a new and effective
minimally invasive technique for open AAA repair. J
Vasc Surg. 2003 Apr;37(4):744-9. Laparoscopy-assisted
abdominal aortic aneurysm endoaneurysmorraphy: early and mid-term
results. Alimi
YS, Di Molfetta L, Hartung O, Dhanis AF, Barthelemy P, Aissi K, Giorgi
R, Juhan C. Department
of Vascular Surgery, Hopital Nord, Universite de la Mediterranee,
Marseilles, France. yalimi@ap-hm.fr OBJECTIVES:
This study was undertaken to evaluate the consequences on patient
selection and on early and mid-term results during the learning curve of
a surgical team performing laparoscopy-assisted surgery to treat
abdominal aortic aneurysm (AAA). PATIENTS
AND METHODS: Between December 1998 and January 2002, 24 patients (22 men,
2 women; mean age, 68.2 years [range, 57-82 years]) were included in a
prospective study and underwent laparoscopic transperitoneal AAA
dissection followed by graft implantation through a 6 to 9 cm
minilaparotomy. Perioperative data for the first 10 patients, obtained
during the first 25 months of the study (group 1), were compared with
data for the last 14 patients, obtained during the last 13 months of the
study (group 2). Follow-up consisted of clinical examination or duplex
scanning, or both, at 1, 3, 6, and 12 months and yearly thereafter, and
computed tomographic scanning before discharge and yearly thereafter. RESULTS:
One patient (4.3%) died in the immediate postoperative period. In this
patient and two others (12.5%), the minilaparotomy was extended
intraoperatively, from 12 cm to 16 cm. With experience, initial
contraindications such as obesity and short proximal or calcified aortic
neck were eliminated, enabling increase in rate of patients included,
from 27.7% during the first 25 first months to 56% during the last 13
months (P =.063). Mean duration of operative clamping decreased from 275
minutes in group 1 to 195 minutes in group 2 (P <.0001), and mean
duration of aortic clamping decreased from 101 minutes in group 1 to 52
minutes in group 2 (P <.0001). The number of early repeat
interventions was reduced
from 3 (30%) in group 1 to 2 (14.3%) in group 2 (P =.61), and clinical
recovery period decreased from 6.8 days to 4.3 days (P <.005). During
mean follow-up of 17.1 months (range, 3-38 months), no late aortoiliac
procedures were necessary and no prosthetic abnormality was detected. CONCLUSION:
This minimally invasive video-assisted technique provides good
postoperative comfort and excellent mid-term results. Developments in
experience and instrumentation have enabled us to include a growing
number of patients and to reduce the duration of the procedure. Ann
Vasc Surg. 2003 Mar;17(2):180-4. Epub 2003 Mar 14. Minimal
incision aortic surgery (MIAS). Turnipseed
WD, Carr SC, Hoch JR, Cohen JR. turnip@surgery.wisc.edu This
study evaluates the clinical and economic impact of using less extensive
minimal invasive aortic surgery (MIAS) for elective treatment of
infrarenal aortic aneurysms (AAA) and aortoiliac occlusive disease (AIOD)
in two independent surgical departments. Surgeons from two institutions
conducted a prospective consecutive, nonrandomized analysis of MIAS
electively performed in 80 patients. MIAS outcomes were compared with 80
consecutive elective standard open aortic procedures (40 from each
institution), which were performed during the same time period. Cost
analyses for MIAS and standard open repair were performed at each
institution. Our results indicated that MIAS is as safe as standard open
repair, is more cost-effective, and has significantly shorter hospital
stays than with standard open repair. Cardiovasc
Surg. 2003 Jun;11(3):179-84. Epidural
analgesia in patients with chronic obstructive pulmonary disease
undergoing transperitoneal abdominal
aortic aneurysmorraphy--a multi-institutional analysis. Bush
RL, Lin PH, Reddy PP, Chen C, Weiss VJ, Guinn G, Lumsden AB. Division
of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey
Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
rbush@bcm.tmc.edu INTRODUCTION:
Patients with chronic obstructive pulmonary disease (COPD) are more
likely to develop pulmonary morbidity following major abdominal surgery.
The purpose of this study was to examine the utility of epidural
analgesia in patients with COPD who underwent elective transperitoneal
abdominal aortic aneurysm (AAA) repair. METHODS: During a 7-year period,
all patients diagnosed with COPD undergoing elective AAA repair (n=425)
from three hospitals were reviewed. Inclusion criteria were an FEV(1)/FVC
ratio <75% and/or a PaCO(2)>45 mmHg. Clinical outcomes were
compared between those who received epidural analgesia (epidural group)
and those who did not (control group). Primary endpoints measured were
duration of intubation, ICU stay, hospital days, and pulmonary
complications. RESULTS:
Strict inclusion criteria were met by 131 patients, which included 86
patients in the epidural group and 45 patients in the control group.
When comparing the epidural vs. control group, the mean AAA size was
6.3+/-0.9 cm vs. 6.0+/-1.5 cm (NS), FEV(1) was 57.2+/-24.7% vs.
49.0+/-10.3% (NS), and the mean FEV(1)/FVC ratio was 52.0+/-11.4% vs.
50.6+/-6.7% (NS), respectively. The epidural group had a significantly
lower incidence of post-operative ventilator dependency and ICU stay
(p<0.05), as well as a decreased trend in pulmonary complications
when compared to the control group. The overall hospital stay remained
similar between the two groups. The relative risk of developing a
pulmonary complication in the absence of epidural analgesia was 2.3. CONCLUSIONS:
Perioperative epidural analgesia is beneficial in patients with COPD
undergoing AAA repair by reducing both the post-operative ventilator
duration and ICU stay. Epidural analgesia should be considered in all
COPD patients undergoing elective transperitoneal AAA repair.
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