Practice variability in the management of subrenal arterial stenoses in seven Belgian hospitals

This multicentre retrospective study describes the variation of therapeutic options, treatment outcomes and costs for treating subrenal arterial stenoses as observed in daily practice in 1997-99 in seven Belgian hospitals. Data were obtained from clinical record review and from the sickness fund claims database, and included preoperative functional state, presence of acute ischaemia, diabetes and polyvascular disease, state of the lower-leg run-off arteries, anatomical site and type of lesion, type of treatment, result at 30 days and up to 4 years. A total of 442 episodes were studied, but most analyses dealt with a subgroup of 240 lesions in the common iliac up to the superficial femoral artery. The proportion of surgical treatments (as compared to an endovascular or mixed approach) varied from 15% to 81% between the hospitals. In univariate patency analysis, relapse or failure rates at 4 years ranged from 5% for the common iliac artery to 35% for the superficial femoral artery. Polyvascular disease, a poor run-off, multiple stenoses and chronic occlusion were significant risk factors; age and diabetes were not. In the multivariate (stratified Cox regression) analysis, only a location in the superficial femoral artery and a poor preoperative clinical stage were significant risk factors, but type of therapeutic approach was not. The total average cost of treatment was 5,300 Euros, of which 15% was contributed by the patient. Surgery was associated with longer stays (median at 12 days) than endovascular treatments (median 2 days), and was 1.9 times more expensive. In conclusion, the results of the present study suggest that a multidisciplinary approach, orienting the patient to the most appropriate therapeutic pathway, could increase both the quality and the cost-effectiveness of the care.

Totally laparoscopic aortobifemoral bypass: a case report

Since a few years, vascular surgeons are becoming interested in laparoscopic vascular techniques. After initial experience with the hand-assisted laparoscopic technique, we now adopt the totally laparoscopic approach for aortoiliac surgery. Our first case with this second technique is presented.

Hand-assisted laparoscopic aortoiliac surgery: preliminary report of 25 cases

INTRODUCTION

Since a few years vascular surgeons are developing laparoscopic vascular techniques. We report our preliminary results in this area, using the hand-assisted technique.

MATERIALS AND METHODS

Twenty-five patients were operated between February and December 2001 using the HandPort-system. Indications were occlusive aortoiliac disease or infrarenal aortoiliac aneurysmal disease.

RESULTS

Mean operating time was 180'; mean aortic clamping time was 37'; mean blood loss was 521 mL. Mean laparotomy length was 7.9 cm. A conversion to a larger laparotomy was necessary in two patients. Mean hospital stay was seven days. Operative mortality was 4% (one postoperative death).

CONCLUSIONS

Hand-assisted laparoscopic aortoiliac surgery is feasible in community hospital settings.

Rupture of a superior mesenteric artery aneurysm in a child

A 13-year-old child presented with a ruptured aneurysm of the trunk of the superior mesenteric artery most likely due to incipient fibromuscular disease localized in the adventitia. The aneurysm was resected and replaced by an autologous saphenous vein graft. The postoperative course was uneventful. Diagnosis and operative strategy are discussed.