Mini-access ascending aorto-bifemoral bypass surgery for the treatment of aortic steno-occlusive disease

Abstract

Objectives: Mid-aortic syndrome is a rare condition characterized by severe aortic narrowing, leading to high upper body blood pressure and organ hypoperfusion, necessitating surgical intervention. Although central bypassing is considered ideal, it involves extensive incisions. To overcome these limitations, less-invasive approaches have been developed. This study aims to introduce a mini-access approach using video-endoscopy and to evaluate the feasibility and outcomes of mini-access ascending aorto-bifemoral bypass surgery.

Methods: From November 2020 to May 2022, we performed ascending aorta to bifemoral artery bypass operations on 7 patients to treat steno-occlusive diseases in the downstream aorta. A Y-graft was created, and procedures were conducted under general anesthesia using video-endoscopy with limited skin incisions.

Results: Intraoperatively, there were no major complications, and none of the patients required cardiopulmonary bypass support. Furthermore, there were no postoperative mortalities or major complications. Postoperatively, the mean ankle-brachial index significantly improved from 0.59/0.59 to 0.96/0.92 (P = .004), and the mean glomerular filtration rate increased from 61.1 to 85.3 mL/min/1.73 mm² (P = .012). Additionally, symptoms of claudication resolved in all patients.

Conclusions: Videoscope-assisted mini-access aortic bypass surgery not only provides favorable early postoperative outcomes but also represents a technically feasible alternative to traditional surgical approaches for the treatment of steno-occlusive aortic diseases.

Keywords: Takayasu arteritis; aortic bypass; minimally invasive surgery.

Video-endoscopic mini-access ascending aorta-bifemoral bypass offers patients a less invasive alternative, free from complications.

Ascending aorto-bifemoral bypassing using videoscope and laparoscopy.

Figure 1

Schematic drawings of the operative plan and an intraoperative picture for Ascending aorto-bifemoral bypassing using videoscope assisted mini-thoracotomy and laparoscopy. A, Limited skin incisions on the right chest, umbilicus and both groins. B, Planning of proximal and distal anastomosis. C, Intraoperative picture after operation with limited skin incisions.

Figure 2

Three-dimensional computed tomography images of patient No. 2. A, Preoperative computed tomography reveals a diffuse narrowing of descending thoracic aorta (minimal diameter: 6.5mm) with multifocal wall calcification observed in the posterior view. B, Postoperative computed tomography reveals a patent bypass graft in the anterior view.

Figure 3

Graphical abstract. Video-endoscopic mini-access ascending aorta-bifemoral bypass offers patients a less invasive alternative, free from complications.