A total laparoscopic technique for endovascular thoracic stent graft deployment.

Abstract

Limitations of endovascular thoracic aneurysm treatment include small, tortuous, or severely calcified iliac arteries. We present our experience with a total laparoscopic access to deploy thoracic endografts. A total laparoscopic left retrocolic approach was used in all cases. A Dacron conduit was laparoscopically sutured to either the iliac artery or to the aorta directly. The endograft was inserted through this conduit. After graft deployment, the Dacron prosthesis was tunneled to the groin and anastomosed with the femoral artery. The laparoscopic procedure could successfully be performed in 11 patients. In six cases, the aorta was used as an access and in five patients, the iliac arteries were preferred. In one of these cases, the right iliac artery was used for deployment of the endograft. After successful aorto- or ileo-femoral bypass grafting, all patients had an improvement of their ankle brachial index postoperatively. The mean operative time was almost four hours, including laparoscopy, laparoscopic anastomosis, endograft deployment, and femoral artery anastomosis or profundaplasty. Totally laparoscopic assisted graft implantation in aorta or iliac arteries provides a safe and effective access for the endovascular delivery system. However, further evaluation and long follow-up are necessary to ensure the potential advantages of this technique. It is a less invasive option to overcome access-related problems with thoracic endograft deployment, giving the patient the advantage of a totally minimal invasive procedure.