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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2000 December;7(4):291-301

language: English, Italian

Aortobifemoral bypass using MIDAS (Minimally Invasive Direct Aortic Surgery)

De Donato G., Weber G. *

From the ASL Nap­o­li I Vas­cu­lar Sur­gery Divi­sion San Gio­van­ni Bos­co Hos­pi­tal II ­Naples Uni­ver­sity (­Prof. G. de Dona­to)
* 1st Depart­ment of Sur­gery Med­i­cal Uni­ver­sity of ­Pécs, Hungary Divi­sion of Vas­cu­lar Sur­gery (­Chief: G. ­Weber, M.D., Ph.D)


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Despite the ­angiosurgeon’s ­best ­efforts and the ­best pos­sible post­op­er­a­tive ­care, the tra­di­tion­al aor­to­bif­e­mo­ral ­bypass pro­ce­dure via the tra­di­tion­al trans­per­it­o­neal ­approach ­that ­involves a ­large ­xipho-­pubic or trans­ver­sal inci­sion is ­still bur­dened by a fair­ly ­high mor­bid­ity and mor­tal­ity ­rate. For ­that rea­son and in ­order to min­i­mise the sur­gi­cal ­stress ­involved, a ­less inva­sive pro­ce­dure has ­been devel­oped ­that ­involves a min­i­lap­a­rot­o­my and a ret­ro­per­i­to­neal ­approach to the aor­ta for the implan­ta­tion of the aor­to­bif­e­mo­ral ­bypass. ­This ­MIDAS (Min­i­mal­ly Inva­sive ­Direct Aor­tic Sur­gery) tech­nique was ­applied to 185 ­patients ­between Octo­ber 1997 and ­March 2000. The ­MIDAS tech­nique ­offers all the advan­tag­es of ­open sur­gery com­bined ­with the ben­e­fits to be ­derived ­from min­i­mis­ing tis­sue trau­ma. ­Access to the infra­ren­al aor­ta is ret­ro­per­i­neal via a 5 cm ­median abdom­i­nal inci­sion. ­This ­series pro­duced 0% intra­op­er­a­tive mor­tal­ity, ­while mor­tal­ity in the imme­di­ate post­op­er­a­tive peri­od ­came to 1.08% ris­ing to 2.76% at 30 post­op­er­a­tive ­days. The ­first 152 ­MIDAS oper­a­tions ­were com­pared to 150 aor­tof­e­mo­ral bypass­es involv­ing con­ven­tion­al lap­a­rot­o­my (CL) and the fol­low­ing param­e­ters ­were mon­i­tored: nas­o­gas­tric drain­age, intes­ti­nal per­is­tal­sis, ­start of feed­ing, pul­mo­nary func­tion, ­time in Inten­sive ­Care, ­length of hos­pi­tal ­stay, sur­gery ­time and ­blood ­loss. ­MIDAS per­formed bet­ter ­under all ­those head­ings and its advan­tag­es may be sum­mar­ised as: ­reduced trau­ma and ­pain, ­less dam­age to pul­mo­nary func­tion and few­er res­pir­a­to­ry com­pli­ca­tions.

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