Endovenous radiofrequency for chronic superficial venous insufficiency: Clinical outcomes and impact in quality of life.

BACKGROUND: Endovenous treatment of lower limb varicose veins is progressively replacing conventional surgery. The authors are investigating radiofrequency (RFA) results in terms of vein occlusion, complications, patient's satisfaction and quality of life in a single centre. METHODS AND MATERIALS: A retrospective analysis of medical charts with a prospective follow-up was performed on data about patients undergoing RFA for insufficiency of great saphenous vein (GSV). RESULTS: A total number of 135 patients (164 limbs) (63% n 85 female; 37% n 50 male; mean age of 53.9 years, range 24-85 years; mean VCSS score (Venous Clinical Severity Score) 6, range 4-22) were included. Complete obliteration of GSV was obtained in 98.2% of the cases. No device- or procedure-related adverse events occurred. No deep venous thromboses, pulmonary embolism, phlebitis, major bleeding, paraesthesia nor skin burn were detected. Patients returned to normal activities in a mean of 8 days (range 5-10). One-month postoperatively, the mean quality of life scores 6 (range 5-9) and mean satisfaction score was 6 (range 4-8) in a scale from 0 to 8. At a median follow-up of 11 months (range 2-18), mean VCSS was 3.9 (range 2-8). CONCLUSIONS: Radiofrequency guarantees good functional outcomes and low rate of complications. It is associated with high satisfaction rate and quality of life score.

Totally laparoscopic tube graft bypass for infrarenal aortic aneurysm: a well-established surgical technique.

Abdominal aortic aneurysm (AAA) repair enters the field of laparoscopic surgery. Main advantage of laparoscopic AAA repair is to perform the gold standard endoaneurysmorraphy with a reduced surgical trauma. Since 2001, the technique has evolved and is now well-established. We describe the standard technique of totally laparoscopic endoaneurysmorraphy with tube graft interposition through a transperitoneal left retrorenal approach. Main technical points are discussed.

Experimental development of an endovascular graft for thoraco-abdominal aortic aneurysm repair.

AIM: Current treatment of thoraco-abdominal aortic aneurysms is surgical. Despite significant advances in surgical technique and anesthetic management, significant morbidity and mortality remain associated with their repair. In compliance with principles of reducing postoperative morbidity, we developed a thoraco-abdominal endovascular graft in experimental models of type III and type IV thoraco-abdominal aortic aneurysm. This device had to preserve the vascularization of the visceral arteries while ensuring full aneurysmal exclusion. METHODS: Six implantations of the endovascular graft were performed. This graft was a modular system, made of: 1) a custom made main body containing 4 prosthetic visceral branches, 2) 4 self-expandable stent-grafts connecting prosthetic visceral branches with visceral arteries, 3) a custom made tubular endovascular graft connecting the main body with one of the iliac arteries. RESULTS: On angiographic controls, full aneurysmal exclusion was achieved while maintaining visceral artery perfusion. At the end of each procedure, the experimental model was opened. Macroscopic examination showed harmonious thoraco-abdominal endovascular graft deployments, without abnormal component constraint or kinking. There was no discordance between macroscopic and angiographic CONCLUSIONS: Our experimental work led to the development of a thoraco-abdominal endovascular graft, demonstrating feasibility of thoraco-abdominal aneurysm endoluminal treatment on an in vitro model close to the anatomical conditions observed in human pathology.

Undiagnosed aorto-caval fistula during total laparoscopic abdominal aortic aneurysm repair: a cause of conversion.

Total laparoscopic aortic repair is evolving and is now the technique of choice for the treatment of infrarenal abdominal aortic aneurysms (AAA) in our department. With growing experience, surgeons will be confronted with the same peroperative situations than open surgery. We report a case of total laparoscopic AAA repair with peroperative diagnosis of aorto-caval fistula (ACF).

Total laparoscopic abdominal aortic aneurysms repair.

AIM: The aim of the study was to describe our experience of total laparoscopic abdominal aortic aneurysm (AAA) repair. METHODS: Between February 2002 and September 2004, we performed 49 total laparoscopic AAA repair in 45 men and 4 women. Median age was 73 years (range, 46-85 years). Median aneurysm size was 52 mm (range, 30-95 mm). ASA class of patients was II, III and IV in 16, 32 and 1 cases, respectively. We used the laparoscopic transperitoneal left retrocolic approach in 47 patients. Seven patients were operated via a tranperitoneal left retrorenal approach and one patient via a retroperitoneoscopic approach. RESULTS: We implanted tube grafts and bifurcated grafts in 19 and 30 patients, respectively. Median operative time was 290 min (range, 160-420 min). Median clamping time was 81.5 min (range, 35-230 min). Median blood loss was 1800 cc (range, 300-6900 cc). Mortality was 6.1% (3 patients). In our early experience, two patients died of myocardial infarction. The 3rd death was due to a multiple organ failure. Thirteen major non lethal postoperative complications were observed in 9 patients (18%). Four patients had local/vascular complications, which required reintervention (8%). Nasogastric tube is now removed at the end of procedure. Median duration of ileus, return to general diet, ambulation and hospital stay were 2, 3, 3 and 10 days. With a median follow-up of 19 months (range, 8-39 months), complete recovery with patent graft was observed in 44 patients. Two patients needed a crossover femoral graft for one iliac dissection and one graft limb occlusion. CONCLUSIONS: These results show that total laparoscopic AAA repair is feasible and worthwhile for patients once the learning curve is overcome. It remains technically demanding and a previous training in videoscopic sutures is essential. Initial learning curve in laparoscopic aortic surgery with aortoiliac occlusive lesions is preferable before to begin laparoscopic AAA repair.

Total laparoscopic aortic surgery: transperitoneal direct approach.

OBJECTIVE: We describe the laparoscopic transperitoneal direct approach to the abdominal aorta. OPERATIVE TECHNIQUE: The patient is placed in the right lateral decubitus position, which allows dropping of the small bowel into right side of the abdomen. Anatomical exposure of the abdominal aorta follows the same steps as in open surgery. DISCUSSION: Laparoscopic transperitoneal direct approach allows a reproducible exposure of the abdominal aorta. This technique was useful when retrocolic and/or retrorenal approaches were not possible because of previous left nephrectomy.