title: Laparo- and thoracoscopic aortic aneurysm neck optimization and treatment of potential endoleaks type IA and II in a porcine model.
abstract: BACKGROUND
  Endovascular repair of aortic aneurysms has a higher incidence of late complications, and open conversion (OC) associated with high mortality may be required. As alternatives to OCs, we propose minimal invasive laparo-/thoracoscopic approaches, either to control endoleaks after endovascular repair, or to convert non-endovascular treatable cases due to a hostile neck anatomy by inserting a peri-aortic PTFE collar before endovascular repair. Such interventions may reduce complications and the necessity for OCs in the future.
  
  
  METHODS
  In twelve pigs, were 10 had infra-/juxtrarenal AAAs, externally placed collars/aneuwraps around the proximal AAA neck and just below the left subclavian artery and division of the aortic side branches were carried out laparo-and thoracoscopically.
  
  
  RESULTS
  For the laparoscopic and thoracoscopic procedures respectively, mean operative time was 143 ± 41 min and 86 ± 51 min and a mean of 2.6 and 2.25 aortic side branches were ligated/divided. For both procedures, the last half in the series were carried out significantly faster (p < 0.05) indicating a learning curve. Blood loss was minimal and no procedure related complications were seen.
  
  
  CONCLUSIONS
  Using these minimal invasive endoscopic approaches, it seems feasible to externally band aneurysm necks and ligate aortic side branches in a pig model. These procedures could potentially be considered as alternatives to OCs in controlling endoleaks and in improving the safety of endovascular interventions. As endoscopic aortic surgery is challenging a learning curve is expected. Practicing the described procedures using this model, can be used as a learning tool prior to similar interventions on humans.
authors.affiliation: Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Heibergs Alle 4, 8800, Viborg, Denmark.
authors.forename: Brian O
authors.initials: BO
authors.lastname: Kloster
authors.affiliation: Department of Urology, OUH Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C., Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Lund
authors.affiliation: Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Heibergs Alle 4, 8800, Viborg, Denmark; Elitary Research Centre of Individualized Medicine in Arterial Diseases (CIMA), Department of Cardiovascular and Thoracic Surgery, OUH Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C., Denmark.
authors.forename: Jes S
authors.initials: JS
authors.lastname: Lindholt
keywords: Animal model; Aortic aneurysms; Endoleaks; Learning curves; Surgical training