A.V. MAKSIMOV^1,2, R.M. NURETDINOV¹, A.K. FEYSKHANOV¹

¹Republican Clinical Hospital of Ministry of Health of the Republic of Tatarstan, 138 Orenburgskiy Trakt, Kazan, Russian Federation 420064

²Kazan State Medical Academy, 11 Butlerova St., Kazan, Russian Federation 420012 

Maksimov A.V. — PhD (Medicine), Head of the Vascular Surgery Department, tel. +7-927-243-42-93, e-mail: maks.av@mail.ru^1,2

Nuretdinov R.M. — cardio-vascular surgeon of the Vascular Surgery Department № 1, tel. +7-927-407-19-02, e-mail: rifkat21@mail.ru¹

Feyskhanov A.K. — cardio-vascular surgeon of the Vascular Surgery Department № 1, tel.+7-987-296-06-42, e-mail: aygizf@rambler.ru¹

The immediate results of 20 bilateral aortofemoral reconstructions performed through minimal retroperitoneal access for the period of 2002-2010 were analyzed.

There were 3 ways of the abdominal wall dissection — the median, subcostal and para/transrectal.

In all cases the aorta exploration was possible only in the range of 2-3 cm above the mouth of the inferior mesenteric artery. The angle of operating action (AOA) at pararectal/transrectal mini-access to the proximal anastomosis was (longitudinal/transverse projection) 61,5º±2,7º/53,5º±3,2º, wound depth — 8,8±0,3/7,8±0,4. In case of median retroperitoneal access of AOA to the proximal anastomosis accordingly was 55,0º±5,0º/46,7º±7,3º, wound depth — 8,7±1,2/9,0±0,6 cm. At subcostal access in all cases AOA was less than 30º (26,3º±2,4/36,3º±5,5º, p<0,05), and the depth of the wound 9,0±0,7/11,0±0,6 cm.

In all cases of subcostal access AOA was less than 30º (26,3º±2,4/36,3º±5,5º, p<0,05), and the depth of the wound — 9,0±0,7/11,0±0,6 cm. Complication rate associated with access was 15% (3 patients). Operation time was 166,8±6,6 min (105-240 min), aorta clamping — 32,4±2,5 min. Conversion of access was required in two cases (10%).

Retroperitoneal mini-access is highly complex. Particularly unfavorable parameters were at subcostal access, thus we no longer use it. Implementation of bilateral retroperitoneal mini-access renovations is justified in certain clinical situations (in case of adhesions in the abdominal cavity, etc.), and under additional conditions (ability of resection of the aorta and the inferior mesenteric artery).

Key words: aortofemoral reconstruction, retroperitoneal mini-access.

REFERENCES

1. Helsby C.R., Moosa A.R. Aortoiliac reconstruction with special reference to the extraperitoneal approach. Br. J. Surg., 1975, vol. 62, pp. 596-600.

2. Nevelsteen A., Smet G. et al. Transabdominal or retroperitoneal approach to the aorto-iliac tract: a pulmonary function study. Eur. J. Vasc. Surg., 1988, vol. 2, no. 4, pp. 229-232.

3. Honig M., Mason R., Giron Wound complications of the retroperitoneal approach to the aorta and iliac vessels. J Vasc Surg., 1992, vol. 15, pp. 28-34.

4. Wirth G., Moccia R. Aortoiliac reconstruction: the retroperitoneal approach and splenic injury. Ann. Vasc. Surg., 2003, vol. 17, no. 6, pp. 604-607.

5. De Donato G., Veber G., De Donato Dzh. Aortobifemoral bypass procedure MIDAS. Angiologiya i sosudistaya khirurgiya, 2002, vol. 8, no. 1, pp. 48-56 (in Russ.).

6. Krasavin V.A. Video Endoscopy assisted operations on the abdominal aorta and iliac arteries of retroperitoneal minidostupa using retractor «SC-1». Angiologiya i sosudistaya khirurgiya, 2010, vol. 15, no. 3, pp. 97-101 (in Russ.).

7. Weber G., Geza J. et al. Aorto-bifemoral bypass through retroperitoneal “mini”-incision (preliminary report). Orv Hetil Review. Hungarian, 1994, vol. 135, no. 37, pp. 493-496.

8. Piquet P., Amabile P., Rollet G. Minimally invasive retroperitoneal approach for the treatment of infrarenal aortic disease. J. Vasc. Surg., 2004, vol. 40, no. 3, pp. 455-462.