25 years of laser assisted vascular anastomosis (LAVA): what have we learned?

OBJECTIVES: Laser assisted vascular anastomosis (LAVA) has been developed to a stage where clinical use is within reach. Advantages of LAVA are minimal vessel damage, faster operation and the potential for minimally invasive application. DESIGN: A Medline literature search was performed on vessel welding combined with cross-referencing. RESULTS: Four different lasers have mostly been used for LAVA, always in combination with stay sutures. The CO(2) laser has only been used in the early period. Without solder, mean leaking point pressures (LPP) of 754 mmHg (n=75) were obtained, only slightly lower than in suture controls (LPP=915 mmHg, n=82). At follow-up the percentage of aneurysms was high (overall 12% in n=486). Although Argon LAVA showed moderate success (LPP=146 mmHg, n=125), the first clinical application has been successfully performed. Diode LAVA in combination with solder and dye resulted in an acceptable LPP of 409 mmHg (n=163) in larger vessels, with a low incidence of aneurysm formation (1% in n=107). CONCLUSION: At present the diode laser is the most popular. Solder developments resulted in stronger welds and might make stay sutures redundant. The combination of CO(2) laser and solders has not been evaluated and deserves further investigation.

Endovascular treatment of thoracic aortic pathology: feasibility and mid-term results.

OBJECTIVE: to report our experience with 21 consecutive patients treated with a thoracic stent-graft. DESIGN: retrospective analysis. MATERIALS AND METHODS: Between October 1998 and February 2002, 21 patients (12 male), mean age 55.6 years (range 19-86 years), were treated for aorticortic pathology localized to the descending aorta (18 patients), the aortic arch (2 patients) and the ascending aorta (1 patient) and comprising true aneurysms (8 patients), false aneurysms (6 patients), traumatic rupture (4 patients), mycotic aneurysms (2 patients), and ruptured aneurysm (1 patient). Plain chest X-rays and computed tomography was performed at 3, 6 and 12 months postoperatively and then annually. RESULTS: the median (range) operation time was 85min (50-305min), hospital stay 6 days (3-63 days) and follow-up 24 months (5-44 months). Complications occurred in 5 patients and comprised intraoperative migration (1), type I endoleak (1), type II endoleak (1), ischemic myelopathy (1), pneumonia (2), suture granuloma (1) and common femoral artery dissection (1). CONCLUSIONS: stent-grafting can be successfully employed to treat a wide range of thoracic aortic pathologies with a mortality, morbidity and resource utilization that is considerably less than that associated with conventional surgery. However, long term follow-up on safety and efficacy is needed.

Adjustable silicone gastric banding: a series with three cases of band erosion.

BACKGROUND: Among the various operations used for surgical treatment of morbid obesity, adjustable silicone gastric banding (ASGB) is the least invasive. Many good results have been described. During extended follow-up, however, serious complications may occur. We briefly describe our results with ASGB and will focus on three cases of band erosion. METHODS: From January 1996 to December 1998, 91 patients underwent laparoscopic adjustable gastric banding in our clinic. Follow-up until now is 100%. RESULTS: Body Mass Index (BMI) in this series decreased from 44.7 at time of operation to 34.8 at 18 months of follow-up (42 patients). Complications, minor and major, occurred in 27.5%. Three patients are described in which the gastric band migrated and had to be removed operatively. CONCLUSIONS: Satisfactory weight loss can be established by ASGB. However, serious and potentially lethal complications can occur. In view of the former Angelchik esophageal antireflux prosthesis, abandoned because of its notorious migration, we must be aggressive in evaluating band migration. Thus, we plead for international registration of adjustable silicone gastric banding.