title: New development for aorto bifemoral bypass--a clampless and sutureless endovascular and laparoscopic technique.
abstract: The classic procedure for aortobifemoral bypass is open surgery. Laparoscopy has been accepted by several authors as a minimal invasive alternative for aortoiliac occlusive disease. The totally retroperitoneal laparoscopic procedure has been described as an alternative to the transperitoneal approach. Whatever the approach, the aortoprosthetic anastomosis is a major difficulty making those techniques unpopular despite obvious advantages for the patients. We report a clampless and sutureless approach for the proximal anastomosis of a totally retroperitoneal laparoscopic aortobifemoral bypass using an EndoVascular REtroperitoneoScopic Technique (EVREST). This approach was proposed to a 56-year-old man with severe aortoiliac occlusive disease. There was no indication for endovascular re-vascularization. The patient was placed in a 30 degrees right lateral decubitus position. The dissection of the retroperitoneal space was performed and the infrarenal aorta was exposed. A bifurcated graft was inserted into the retroperitoneal space. Under videoscopic control the prosthetic limbs were brought to the groins. The main body of the graft was connected on the left side of the aorta by an intra and extra aortic covered stent-graft. This connection was performed without the use of an aortic clamp and without suture. The femoral anastomoses were performed by classic open surgery.
authors.forename: Bernard
authors.initials: B
authors.lastname: Segers
authors.forename: David
authors.initials: D
authors.lastname: Horn
authors.forename: Michel-Olivier
authors.initials: MO
authors.lastname: Bazi
authors.forename: Jean
authors.initials: J
authors.lastname: Lemaitre
authors.forename: Vanessa
authors.initials: V
authors.lastname: Van Den Broeck
authors.forename: Etienne
authors.initials: E
authors.lastname: Stevens
authors.forename: Alain
authors.initials: A
authors.lastname: Roman
authors.forename: Thierry
authors.initials: T
authors.lastname: Bosschaerts
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000792:Angiography / Q000379:methods; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space / Q000601:surgery; D012720:Severity of Illness Index; D015607:Stents; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods