title: A comparative cohort study of totally laparoscopic and open aortobifemoral bypass for the treatment of advanced atherosclerosis.
abstract: BACKGROUND
  Totally laparoscopic aortobifemoral bypass (LABF) procedure has been shown to be feasible for the treatment of advanced aortoiliac occlusive disease (AIOD). This study compares the LABF with the open aortobifemoral bypass (OABF) operation.
  
  
  METHODS
  In this prospective comparative cohort study, 50 consecutive patients with type D atherosclerotic lesions in the aortoiliac segment were treated with an LABF operation. The group was compared with 30 patients who were operated on with the OABF procedure for the same disease and time period. We had an explanatory strategy, and our research hypothesis was to compare the two surgical procedures based on a composite event (all-cause mortality, graft occlusion, and systemic morbidity). Stratification analysis was performed by using the Mantel-Haenszel method with the patient-time model. Cox multivariate regression method was used to adjust for confounding effect after considering the proportional hazard assumption. Cox proportional cause-specific hazard regression model was used for competing risk endpoint.
  
  
  RESULTS
  There was a higher frequency of comorbidity in the OABF group. A significant reduction of composite event, 82% (hazard ratio 0.18; 95% CI 0.08-0.42, P=0.0001) was found in the LABF group when compared with OABF group, during a median follow-up time period of 4.12 years (range from 1 day to 9.32 years). In addition, less operative bleeding and shorter length of hospital stay were observed in the LABF group when compared with the OABF group. All components of the composite event showed the same positive effect in favor of LABF procedure.
  
  
  CONCLUSIONS
  LABF for the treatment of AIOD, Trans-Atlantic Inter-Society Consensus II type D lesions, seems to result in a less composite event when compared with the OABF procedure. To conclude, our results need to be replicated by a randomized clinical trial.
authors.affiliation: Department of Vascular Surgery, Heart, Lung and Vascular Disease Clinic, Oslo University Hospital, Oslo, Norway.
authors.forename: Syed S H
authors.initials: SS
authors.lastname: Kazmi
authors.affiliation: Department of Vascular Surgery, Heart, Lung and Vascular Disease Clinic, Oslo University Hospital, Oslo, Norway ; Faculty of Medicine, Oslo University, Oslo, Norway.
authors.forename: Jørgen Junkichi
authors.initials: JJ
authors.lastname: Jørgensen
authors.affiliation: Department of Vascular Surgery, Heart, Lung and Vascular Disease Clinic, Oslo University Hospital, Oslo, Norway.
authors.forename: Jon Otto
authors.initials: JO
authors.lastname: Sundhagen
authors.affiliation: Department of Vascular Surgery, Heart, Lung and Vascular Disease Clinic, Oslo University Hospital, Oslo, Norway ; Faculty of Medicine, Oslo University, Oslo, Norway.
authors.forename: Anne Helene
authors.initials: AH
authors.lastname: Krog
authors.affiliation: Department of Vascular Surgery, Heart, Lung and Vascular Disease Clinic, Oslo University Hospital, Oslo, Norway.
authors.forename: Tor L
authors.initials: TL
authors.lastname: Flørenes
authors.affiliation: Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Dagfinn
authors.initials: D
authors.lastname: Kollerøs
authors.affiliation: Faculty of Medicine, Oslo University, Oslo, Norway ; Unit of Epidemiology and Biological Statistics, Faculty of Medicine, Oslo University, Oslo, Norway ; Centre for Clinical Heart Research, Faculty of Medicine, Oslo University, Oslo, Norway.
authors.forename: Michael
authors.initials: M
authors.lastname: Abdelnoor
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D050197:Atherosclerosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016063:Blood Loss, Surgical; D018572:Disease-Free Survival; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058226:Plaque, Atherosclerotic; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods* / Q000401:mortality
keywords: aortic surgery; aortobifemoral bypass; aortoiliac atherosclerosis; atherosclerosis; competing risk analysis; laparoscopy; minimally invasive surgery