Lower extremity vascular reconstruction and endovascular surgery without preoperative angiography.

BACKGROUND: Recent studies have shown the feasibility of performing lower extremity revascularization based on noninvasive vascular studies alone. METHODS: We undertook a prospective study of patients with lower extremity ischemia who underwent revascularization without preoperative angiography. Preoperative evaluation was done with noninvasive studies including segmental pressures, ankle arm index, duplex scan, and selective use of magnetic resonance angiography. Intraoperative angiography and intra-arterial pressure measurements were used prior to revascularization. Standard patency analysis and follow-up examination were performed. RESULTS: In all, 47 patients underwent 65 procedures (27 iliac, 38 infrainguinal) over a 3-year period. Intraoperative angiography and operative findings correlated with the noninvasive studies. There was one immediate failure, and life table analysis demonstrated primary patency rates of 92% for iliac reconstruction (29 months) and 82% for infrainguinal reconstruction (40 months). CONCLUSION: Preoperative evaluation for lower extremity revascularization utilizing only noninvasive vascular testing gives satisfactory results and is a safe and potentially durable alternative to routine preoperative angiography in most cases.

Thoracoscopic sympathectomy: a case report.

Thoracoscopic sympathectomy was first described in 1951 but was not popularized until this decade. With the advent of videoendoscopic techniques and advances in minimally invasive surgery, thoracoscopic sympathectomy has been shown to be a safe and effective therapy in the treatment of various autonomically mediated disorders. Furthermore, numerous investigators have reported high rates of technical success and patient satisfacrion. These minimally invasive techniques used to resect the sympathetic ganglia significantly reduces the morbidity and mortality often associated with conventional open procedures. In addition, endoscopic techniques provide a magnified view of the surgical field and allow for precise identification of the sympathetic chain and points of resection.

Laparoscopic aortobifemoral bypass.

PURPOSE: To determine the potential benefits of applying laparoscopic techniques for the intraabdominal insertion of aortofemoral grafts and to compare results with those of conventional surgery. METHODS: Having previously demonstrated the feasibility of a totally laparoscopic aortofemoral bypass technique using carbon dioxide peritoneal insufflation in a porcine model, we now report our first human experience with this laparoscopic technique in a 49-year-old man. RESULTS: The patient's postoperative course was marked by his minimal requirements for analgesia, early ambulation, and discharge from the hospital in the morning of the third postoperative day. CONCLUSIONS: The benefits of a laparoscopic approach to aortobifemoral bypass grafting in terms of financial savings and earlier rehabilitation in this patient was significant. This less-invasive procedure warrants further investigation.

Laparoscopic aortobifemoral bypass: a case report.

In the past six years, laparoscopic surgery has gained widespread acceptance by both surgeon and patient. When compared to open surgical approaches, laparoscopic techniques for abdominal procedures lessen postoperative pain and morbidity, improve cosmesis, reduce hospital stay, facilitate early rehabilitation and return to normal activities. The application of laparoscopic techniques to intra-abdominal vascular procedures can be expected to provide similar benefits over conventional surgery.