title: Preliminary results from a prospective study of laparoscopic aortobifemoral bypass using a clampless and sutureless aortic anastomotic technique.
abstract: OBJECTIVE
  This prospective study describes the feasibility and safety of a new clampless and sutureless aortic anastomotic technique used during retroperitoneal laparoscopic aortobifemoral bypass in extensive aortoiliac occlusive lesions. This is a case series of a previously published technique, demonstrating wider applicability of the technique.
  
  
  METHODS
  Twelve patients underwent a clampless and sutureless laparoscopic bypass for TASC D aortoiliac occlusive lesions using the EndoVascular REtroperitoneoScopic Technique (EVREST). Dissection of the retroperitoneal space and the infrarenal aorta was performed laparoscopically. A bifurcated graft was inserted into the retroperitoneal space. The main body of the graft was connected on the left side of the aorta by an intra- and extra-aortic covered stent-graft. An aortic clamp was used temporarily on four patients because of excessive bleeding when the connector was deployed. The femoral anastomoses were performed by classic open surgery. Initial technical success, complications, and bypass patency were assessed.
  
  
  RESULTS
  Median follow-up was 9.3 months. Median operative time was 265 minutes. Median duration of aorto-prosthetic connection was 60 seconds. Thirty-day postoperative mortality was 0%. No major postoperative complications were observed. All grafts were patent at the end of follow-up and there was no early or late disruption of the proximal assembly.
  
  
  CONCLUSIONS
  EVREST greatly facilitates laparoscopic aortic surgery in occlusive disease with no need for suture or clamping of the aorta. This technique performed in a single center on 12 patients, seems to be feasible and safe. It offers the advantages of laparoscopy and those of endovascular surgery, especially in the challenging conditions encountered during aortic laparoscopic surgery. Early experience supports procedural and initial postprocedural safety and demonstrates proof-of-concept for EVREST.
authors: Department of Vascular and Thoracic Surgery, Hôpital Universitaire St Pierre, Brussels, Belgium. Electronic address: bernard_segers@stpierre-bru.be.
authors: B
authors: B
authors: Segers
authors: Department of Vascular and Thoracic Surgery, Hôpital Universitaire St Pierre, Brussels, Belgium.
authors: D
authors: D
authors: Horn
authors: Department of Vascular and Thoracic Surgery, Hôpital Universitaire St Pierre, Brussels, Belgium.
authors: J
authors: J
authors: Lemaitre
authors: Intensive Care Unit, Hôpital Universitaire St Pierre, Brussels, Belgium.
authors: A
authors: A
authors: Roman
authors: Intensive Care Unit, Hôpital Universitaire St Pierre, Brussels, Belgium.
authors: E
authors: E
authors: Stevens
authors: Department of Anesthesiology, Hôpital Universitaire St Pierre, Brussels, Belgium.
authors: V
authors: V
authors: Van Den Broeck
authors: Department of Vascular and Thoracic Surgery, Hôpital Universitaire St Pierre, Brussels, Belgium.
authors: P
authors: P
authors: Hizette
authors: Department of Vascular and Thoracic Surgery, Hôpital Universitaire St Pierre, Brussels, Belgium.
authors: T
authors: T
authors: Bosschaerts
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000792:Angiography; D001012:Aorta, Abdominal / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Aortobifemoral bypass; Aortoiliac occlusive disease; Clampless; Laparoscopic aortic bypass; Retroperitoneoscopy; Sutureless