Electron nanoprobe induced oxidation: a simulation of direct-write purification.

Electron beam direct-write has recently taken a large step forward with the advent of methods to purify deposits. This development has opened the door for future direct-write device prototyping and editing. In one such approach, an additional beam scanning procedure removes carbonaceous impurities via oxidation from metal-carbon deposits (e.g., PtC5) in the presence of H2O or O2 after deposition. So far, critical aspects of the oxidation reaction remain unclear; experiments reveal clearly that electron stimulated oxidation drives the process yet it is not understood why H2O purifies by a bottom-up mechanism while O2 purifies from the top-down. The simulation results presented here suggest that the chemisorption of dissolved O2 at buried Pt nanoparticle surfaces controls purification in the top-down case while both the high relative solubility coupled with weak physisorption of H2O explains the bottom-up process. Crucial too is the role that the carbonaceous contaminant itself has on the dissolution and diffusion of O2 and H2O. These results pave the way for simulation driven experiments where (1) the transient densification of the deposit can be accounted for in the initial deposit design stage and (2) the deposition and purification steps can be combined.

Current strategies and possible perspectives of ultrasonic risk stratification of ischemic stroke in internal carotid artery disease.

Atherosclerotic alterations of the internal carotid artery frequently result in ischemic stroke. However, it remains unclear which specific factor mainly causes an increased risk of stroke. Constant improvements of the diagnostic possibilities of ultrasonic examinations provide increasingly profound insight into plaque alterations. If "risk plaque" could be reliably identified, the therapeutic decision for either medical or surgical treatment could be made more rationally. In this review, we summarize current developments in the ultrasound imaging of atherosclerotic changes in carotid artery disease with special emphasis on technical aspects and the rationale of contrast imaging of plaque vascularization. Methodological limitations and possible future applications are discussed.

Pelvic vein incompetence influences pain levels in patients with lower limb varicosity.

PURPOSE: To detect the influence of pelvic vein incompetence (PVI) on pain levels in patients with varicosity of the lower limb. MATERIALS AND METHODS: Women of child-bearing age with symptomatic primary or recurrent varicosity of the greater saphenous vein (GSV) were prospectively included in two groups depending on the presence or absence of phlebographic signs of PVI. Pain assessment was carried out with the help of a visual analogue scale (VAS). RESULTS: Forty women were included in the study. Nineteen of them had phlebographic evidence of PVI (group A), whereas 21 were included in the control group (group B). Patients of group A reported a higher median total pain level than patients of group B (group A median 62, range 25-100; group B median 32, range 0-100; P = 0.001). In group A, patients experienced a median level of pain of 67.2 at the lower limb in the standing position (range 40-100) versus a median of 50.3 (range 36-81) in patients of group B (P = NS). The median level of leg pain in the sitting position was 41.2 (range 0-67) in patients of group A and 38.1 (range 0-46) in women of group B (P = NS). Pelvic pain level in the standing position was higher (P = NS) in patients of group A (median 72.2, range 50-91), than in women of group B (median 20.1, range 0-41). In patients of group A, statistically significant (P = 0.0001) higher VAS scores for pelvic pain level in sitting (group = A median 67.2, range 59-71; group B median 18.1 range 0-35) were reported. CONCLUSIONS: In a small population of patients with GSV varicosity, overall pain levels were significantly higher in a subgroup of patients with phlebographic signs of PVI. This finding suggests that the presence of PVI might influence the intensity of varicosity symptoms.

Long-term results after transfemoral venous thrombectomy for iliofemoral deep venous thrombosis.

OBJECTIVE: In patients presenting with extensive venous thrombosis affecting the pelvic veins, transfemoral venous thrombectomy has been suggested as an effective treatment in selected patients. We present our experience of this technique as well as its long-term results. PATIENTS AND METHODS: Between January 1998 and January 2008, a total of 83 patients underwent transfemoral venous thrombectomy in our Department of Vascular Surgery. In 22 cases, this was combined with angioplasty and stenting of an iliac vein stenosis. Isolated intra-operative thrombolysis was performed in eight cases to treat deep venous thrombosis (DVT) affecting veins distal to the common femoral vein. All patients suffered from a DVT involving the pelvic veins. A DVT involving all venous segments from the pelvis to the calf was present in 63% of cases. Patients were followed up at 3 months, 6 months and yearly thereafter by clinical and duplex ultrasound examination. RESULTS: In all patients, the procedure was successful in achieving re-canalisation of the pelvic veins at the end of the operation. Perioperatively, there was no mortality and there was no case of clinically detected pulmonary embolism. Life-table analysis showed that, after a mean duration of 60 months following treatment, approximately 75% of the treated venous segments remained patent. Moderate post-thrombotic syndrome (PTS; clinical severity, etiology, anatomy and pathophysiology (CEAP) C2-C4) was present in 20% of cases; severe PTS (CEAP C5 and C6) did not occur in any of the treated patients. CONCLUSIONS: It is safe and effective to treat extensive iliofemoral DVT using transfemoral venous thrombectomy and this prevents the development of severe PTS in the long term. The procedure is only feasible in a subset of patients with DVT, depending on the extent and the age of the thrombosis.

Oestradiol levels in varicose vein blood of patients with and without pelvic vein incompetence (PVI): diagnostic implications.

PURPOSE: To assess the difference in the oestradiol levels of blood taken from varicose veins in patients with and without pelvic vein incompetence (PVI). MATERIALS AND METHODS: Women of child-bearing age with symptomatic primary or recurrent varicose veins of the great saphenous vein (GSV) were included in a prospective study. Patients underwent duplex ultrasonography and pelvic vein phlebography. They were divided into a group with PVI (PVI group) and a control group with GSV reflux alone (VV group). Blood samples were collected from the GSV at the sapheno-femoral junction or lower in the thigh as well as from the arm. Oestradiol levels were determined by electroluminescence. RESULTS: Between January and December 2007, 40 women were studied, of which 19 showed phlebographic evidence of PVI (PVI group), while 21 were included in the VV group. Phlebography revealed an incompetent ovarian vein in 14 (74%) patients of the PVI group, dilated uterine and ovarian plexuses in 12 (63%) and an incompetent internal iliac vein in six cases (32%). In the PVI group, the median oestradiol level in GSV samples was 121 pgml(-1) (range: 12-4300), while in the VV group the median level was 75 pgml(-1) (range: 9-1177). In the upper limb, the PVI group patients had a median level of 78 pgml(-1) (range: 15-121) and the VV group patients 68 pgml(-1) (range: 13-568). The ratio of lower limb/upper extremity was significantly higher (p<0.002) in patients of PVI group (median: 1.9; range: 0.7-33) than in those of the VV group (median: 1.1; range: 0.8-13). A threshold ratio of 1.4 showed the highest combined sensitivity and specificity in differentiating patients with PVI from those without. CONCLUSIONS: In patients with varicose veins arising from the GSV, oestradiol levels were significantly higher in the lower limb than in the upper extremity in the subgroup with associated PVI. It may be possible to use this observation as a diagnostic test in patients with suspected PVI. This deserves further study.

Salvage of a dialysis angioaccess by bypassing a central venous obstruction to the common femoral vein.

We describe the case of a 71 year-old male patient undergoing haemodialysis who presented with severe symptoms of venous hypertension at the left upper extremity due to subclavian and innominate vein obstruction. The patient had a well functioning ispilateral angioaccess. The pain and disabling swelling of the upper extremity developed 12 months after having a radio-cephalic arteriovenous fistula performed and progressively worsened in the last two months. The patient underwent extraanatomic axillo-femoral venous bypass grafting with a 8 mm polytetrafluoroethylene graft to the ispilateral common femoral vein. The postoperative recovery was regular and the patient was discharged 6 days after surgery with a functioning bypass and relief from the venous hypertension symptoms. In this case, surgical bypassing of a central venous obstruction through an extra-anatomical pathway relieved the symptoms of venous hypertension and prolonged the use of the haemodialysis access.

Pelvic venous incompetence: reflux patterns and treatment results.

OBJECTIVE: To assess reflux patterns and the results of endovascular obliteration of ovarian veins in patients with symptomatic pelvic venous incompetence (PVI). METHODS: A total of 71 female patients (mean age 49 years) with signs of PVI on selective phlebography of the pelvic veins were included in the study. In 53 cases (75%), recurrent varicose veins following previous surgery and stripping of the great saphenous vein were present and 51 patients (72%) were multiparous (> or = 2 children). Symptoms were scored on a visual analogue scale (VAS) assessing pelvic and lower limb pain. After duplex ultrasonography of the lower limb veins, in cases of suspected PVI, the presence of any reflux in the ovarian and pelvic veins was demonstrated by phlebography. In selected cases, endovascular treatment with embolisation was used. Follow-up assessment of symptoms was carried out at 1, 2 and 3 years. RESULTS: The left ovarian vein (OV) and the right internal iliac vein (IIV) were most frequently affected by reflux (n=41, 58% each). In about half the number of patients, reflux was demonstrated in more than one of the main pelvic veins (n=38, 54%). An extension of reflux into varicose veins of the groin or lower limb was demonstrated in 44 patients (62%); 35 patients (49%) received treatment for their PVI by coil embolisation. Fifty-five patients (77%) completed follow-up. Patients with isolated ovarian vein incompetence, who were treated by embolisation, experienced a significant improvement of symptoms (mean symptom score 5.2 standard deviation (SD) 3.5 before and 1.2 SD 0.9 after embolisation treatment; p<0.0001), while patients with untreated incompetence did not show improvement in symptoms (mean score 4.5 SD 1.6 before and 5.1 SD 1.5 after conservative treatment; non-significant (N.S.)). Improved symptoms were detected in patients with isolated IIV incompetence, who underwent embolisation treatment (mean symptom score 5.1 SD 2.5 before and 2.1 SD 1.6 after treatment; N.S.) although this did not reach statistical significance. Conservative treatment of patients with isolated IIV incompetence resulted in no relevant changes (mean score 4.2 SD 2.0 before and 4.5 SD 2.1 after treatment; N.S.). Worsening of symptoms was found in patients with combined reflux who underwent conservative treatment (mean score 5.3 SD 2.0 before and 6.5 SD 2.5 after treatment, N.S.). In case of combined OV and IIV reflux, isolated interventional treatment of incompetent ovarian veins did not improve symptoms at each interval of the follow-up (mean score 5.2 SD 2.1 before and 5.1 SD 2.6 after treatment, N.S.), while coiling of all reflux pathways resulted in symptom reduction; but this did not reach statistical significance due to the small numbers of patients (mean score 5.6 SD 2.2 before and 3.2 SD 2.1 after treatment, N.S.). CONCLUSIONS: Combined reflux in more than one pelvic vein is common. In these cases, isolated treatment of ovarian veins or conservative treatment is associated with a poor midterm clinical outcome. A clinical improvement was achieved only in patients with isolated ovarian vein incompetence.

[False aneurysm of the deep femoral artery due to pertrochanteric fracture of the hip with displaced fragment of the lesser trochanter]. / Aneurysma spurium der A. profunda femoris - Komplikation nach pertrochantärer Femurfraktur mit Dislokation des Trochanter minor.

We report the case of an 82-year-old man with a pertrochanteric fracture of the hip and an avulsion of the lesser trochanter. During the third postoperative week after unproblematic correction with a gamma nail, a swelling of the proximal thigh occurred. Angiographs showed a false aneurysm of the deep femoral artery which was treated by suture.

Deep venous thrombosis in a patient with large uterine myomata. Case report.

A 42-year-old woman was admitted with a painful swelling of the left lower limb. Computed tomography revealed an inhomogenous uterine enlargement due to multiple myomata producing a thrombotic occlusion of the left iliac veins. Surgical treatment consisted of isolated hysterectomy. During the same operation, transfemoral thrombectomy and stent implantation in the iliac vein were performed. Hysto-logic examination revealed numerous leiomyomata as well as an endometriosis. The patient recovered well and is pain-free six months after surgery. The deep venous system is still patent at follow-up. Uterine myomata rarely cause acute iliac vein thrombosis due to direct compression. This case represents an example of successful therapy using an interdisciplinary approach.

MR venography in the detection of pelvic venous congestion.

PURPOSE: To investigate the feasibility of using magnetic resonance venography (MRV) to detect pelvic venous congestion (PVC). METHODS: A prospective study of 23 female patients with signs and symptoms of PVC, who underwent duplex sonography, MRV and phlebography (P). Examinations were interpreted in a blinded fashion. Visualization of venous anatomy, presence of venous incompetence and congestion grade were evaluated. Sensitivity and specificity of MRV using P as reference were calculated. RESULTS: MRV agreed with P in 96% (Cohen-K-value 0.646) and in 70% (K 0.555) of the cases respectively in the venous anatomy and congestion grade. Sensitivity and specificity of MRV were 88% and 67% for ovarian veins, 100% and 38% for hypogastric veins and 91% and 42% for the pelvic plexus. CONCLUSIONS: In this prospective study MRV showed high sensitivity in the evaluation of patients with suspected PVC. Routine use of this diagnostic method requires further studies in larger patient cohorts.

Acute iliofemoral deep venous thrombosis due to giant ovarian tumor: report of a hybrid treatment.

Ovarian tumors rarely cause acute iliofemoral thrombosis due to direct compression. This case represents an example of successful therapy using an interdisciplinary approach. A 37-year-old woman was admitted with a painful swelling of the left lower limb. Computed tomography revealed a giant abdominal mass originating from the left ovary producing a thrombotic occlusion of the left iliofemoral veins. Surgical treatment consisted of complete tumor removal, adnexectomy and appendectomy. During the same operation, transfemoral thrombectomy and stent implantation in the iliac vein were performed, followed by creation of an arteriovenous fistula in the left groin. Hystologic examination revealed a well-differentiated mucinous ovarian adenocarcinoma. The patient recovered well and is tumor-free 6 months after surgery. The deep venous system is still patent at follow-up. In this case, minimal surgical trauma and complete tumor as well as thrombus removal succeeded through a positive complementary interdisciplinary approach.

Residual stumps associated with inguinal varicose vein recurrences: a multicenter study.

PURPOSE: It is unclear whether a residual sapheno-femoral stump left in place after stripping of the great saphenous vein can contribute to the formation of late inguinal varicose vein recurrence. In order to obtain information about the time course of recurrence development, patients with histologically proven residual stumps were recruited and asked about the interval between the initial operation and the first clinical signs of varicose vein recurrence. METHODS: A multi-centre study involving 7 centres was conducted amongst patients undergoing redo-surgery for inguinal varicose vein recurrences. The sapheno-femoral stumps resected during the redo-surgery were classified histologically. Patients with a proven long residual sapheno-femoral stump were asked to describe the first signs of varicose vein recurrence with the help of a standardised questionnaire. From these data the symptom-free interval, consisting of the time frame between the initial operation and the first signs of recurrence, was determined. RESULTS: In 279 legs of 251 patients a long residual sapheno-femoral stump was present. Most patients had experienced a symptom-free interval after the initial operation with a mean duration of 7.4 S.D. 5.5 years. Recurrent varicose veins became apparent after a mean time interval of 6.3 S.D. 5.3 years and congestion symptoms occurred after a mean interval of 8.5 S.D. 5.7 years. CONCLUSIONS: In patients with symptomatic groin recurrences, a long residual sapheno-femoral stump was found in about two thirds of cases. The first clinical signs of varicose vein recurrence can be expected 7-8 years after the initial treatment at the earliest. Long term follow up is required reliably to asses the outcome of treatment for varicose veins.

Is initial success of thrombolytic therapy with rt-PA in patients with lower limb ischemia durable? A long-term follow-up series.

BACKGROUND: Catheter-directed intraarterial thrombolytic therapy with rt-PA has been established as an alternative to surgery in selected patients with lower limb ischemia. The purpose of this study is to evaluate its long-term results and to try to identify patient variables influencing outcome. PATIENTS AND METHODS: The results of thrombolytic treatment for acute or subacute lower limb ischemia in 82 patients (51 male, 31 female) were retrospectively analysed. Clinical data (time of symptoms onset, clinical stage, type of affected vessel, anatomical localisation) as well as comorbidities were recorded. The success rate of thrombolysis as well as the incidence of adverse events was evaluated. Patients with initial success were followed up after a median of 52,5 months. RESULTS: Thrombolytic therapy was successful in 67 cases (82%). An additional endovascular or surgical procedure was necessary in 39 of these patients (48%). The overall bleeding rate was 18% and the mortality and major amputation rate was 1%. 42 patients with early clinical success were available for follow-up. 34 of them (81%) were free of ischemic symptoms and the overall limb salvage rate was 96%. We could not identify factors significantly influencing early or long-term results, although there was a trend towards better results in patients with acute ischemia and in patients with occluded native arteries. CONCLUSIONS: Intraarterial local thrombolytic therapy has a relatively high initial success rate in selected patients with lower limb ischemia, but is associated with a significant number of bleeding complications. Furthermore, additional procedures are required in almost half the patients. Initial success is durable at the long-term in the majority of cases. Better selection of patients and refinements of the thrombolytic therapy might help to further improve results and lower the bleeding complications.

Dacron patch infection after carotid angioplasty. A report of 6 cases.

OBJECTIVE: We describe our experience with Dacron patch infections after carotid endarterectomy (CEA). REPORT: From 633 patients undergoing carotid endarterectomy with Dacron patching, six re-presented with prosthetic infections. In 3 of the 6 cases a neck haematoma had necessitated surgical revision after the original carotid surgery. Five patients underwent interposition vein grafting and 1 vein patch angioplasty. Postoperatively, 2 patients developed a repeat infection including the 1 patient with patch angioplasty. All patients were free of infection and neurological symptoms after a maximum follow-up of 56.5 months. CONCLUSION: Following the development of haemorrhage or wound complications careful clinical surveillance should be carried out after carotid reconstruction.

Distal revascularization-interval ligation for the treatment of angioaccess-induced ischemia. Case report.

Two cases of upper extremity ischemia due to a steal phenomenon occurring after the creation of an arterio-venous fistula (AVF) for hemodialysis access are described. A successful treatment with a brachial to brachial artery vein bypass and a ligation of the artery distal to the AVF origin (DRIL-Procedure) was performed in both cases. Complete disappearance of symptoms and healing of the ischemic lesions with maintaining of the angioaccess patency 6 months after the repair reveal that this procedure corrected the stealing.

[Clinical and functional results after transfemoral thrombectomy for iliofemoral deep venous thrombosis: a 5-year-follow-up]. / Klinische und funktionelle Ergebnisse nach transfemoraler Thrombektomie bei tiefer Bein- und Beckenvenenthrombose: ein 5-Jahres-Follow-up.

PURPOSE: The optimal therapy of deep pelvic and leg venous thrombosis is still a matter of debate. The purpose of our study was to evaluate early and late results of iliofemoral thrombectomy with regard to the prevention of the development of a postthrombotic syndrome. METHODS: Between 1996 and 2000, 57 patients underwent transfemoral venous thrombectomy for acute iliofemoral thrombosis. 30 patients were reexamined after a mean of 60.4 months. At follow-up, the patency of the venous segments as well as the development of reflux was investigated by duplex-ultrasound. Furthermore, clinical signs and symptoms of chronic venous insufficiency as well as the subjective satisfaction of the patients with the operation were recorded. RESULTS: Postoperatively the veins of the lower leg were completely recanalized in 25 % of the cases, those of the thigh in 52.3 %. The patency rate at the level of the groin, the pelvis and the caval vein were 92.5, 86 and 100 %, respectively. At follow-up, the veins of the lower limb, the thigh and the pelvis were patent in 76.7 % each and in 73.3 % at groin-level. The caval vein was completely recanalized in all cases. Reflux occurred in 12 patients. 26.7 % of the patients showed no signs of a postthrombotic syndrome. 63.3 % had mild changes including dilated superficial veins and swelling tendency, and only in 10 % trophic skin changes were apparent. A healed or active ulceration did not occur in any case. Except one, all patients were satisfied with the results of the thrombectomy. CONCLUSIONS: Transfemoral thrombectomy for acute iliofemoral venous thrombosis offers good early and late results in terms of preserving venous function and reducing symptoms of venous insufficiency. In our patient population, the development of a severe postthrombotic syndrome could be reduced effectively.

Laparoscopic ligation of the infrarenal vena cava in combination with transfemoral thrombin infusion: a new animal model of chronic deep venous thrombosis.

OBJECTIVE: We describe a new technique to create an animal model of chronic venous thrombosis. The morphological and histological properties of the resulting thrombi are described. METHODS: Thirteen pigs underwent laparoscopic ligation of the infrarenal vena cava in combination with transfemoral thrombin infusion. After 1, 3, 6, 9, 12 and 15 days, respectively, two animals were killed and the thrombosed vein segments were explanted. After recording their weight and dimensions, the thrombi underwent histological examination by light microscopy. RESULTS: In all 13 cases, the procedure was completed laparoscopically and all 13 animals survived the procedure. While 12 pigs (92%) had an uneventful postoperative course, one animal died on the first postoperative night of an unknown cause. Autopsy revealed correct placing of the ligature with occlusive thrombosis of the inferior vena cava and the iliac veins in 12 animals, in one animal the ligature had been incorrectly placed around the origin of the right iliac vein with thrombosis limited to that vessel. Histological evaluation demonstrated mixed thrombi that showed increasing signs of organisation with advancing age. CONCLUSIONS: Laparoscopic ligation of the infrarenal vena cava in combination with transfemoral thrombin infusion is a safe and reliable way to produce chronic venous thrombosis in an animal model. The resulting thrombi are comparable to human deep venous thrombosis in terms of extent, size and organisation process.

The HIB database of annotated UniGene clusters.

SUMMARY: The HumanInfoBase (HIB) is a database of putative human gene transcripts. UniGene clusters are assembled, and the resulting consensus sequences are submitted to the PEDANT software system (Frishman,D., Albermann,K., Hani,J., Heumann,K., Metanomski,A., Zollner,A. and Mewes,H.-W., 2001, Bioinformatics, 17, 44--57) for fully automatic sequence analysis and annotation. Predicted transcripts are classified using a variety of functional and structural categories, and hyperlinks to various databases are provided for additional information. A WWW-based graphical user interface represents the assembly process as well as functionally important sites in the putative transcripts.

[Intraoperative and early postoperative results after laparoscopic implantation of aortofemoral bifurcation prostheses]. / Intra- und frühpostoperative Ergebnisse nach laparoskopischer Anlage aortofemoraler Bifurkationsprothesen.

PURPOSE: The evaluation of multiple intra- and early postoperative parameters in patients undergoing laparoscopic aortobifemoral bypass grafting. METHODS: The charts of 22 patients who underwent laparoscopic aortobifemoral grafting between February 2nd, 1996 and April 30th, 1999 were retrospectively reviewed. RESULTS: All patients were men. The mean age was 54 +/- 7.2 years with the mean body weight being 76.3 +/- 10.9 kg and the Body-Mass-Index (BMI) 23 +/- 2.8. Claudication was present in 20 patients; one patient had rest pain and one patient suffered from tissue loss. The mean Ankle-Brachial-Index (ABI) was 0.57 +/- 0.1. In four cases conversion to open technique became necessary. The mean operation time was 316 +/- 73 min and the mean aortic cross-clamp time was 73 +/- 20 min. The mean intraoperative blood-loss reached 689 +/- 461 ml. The mean duration of postoperative ventilator support was 6.0 +/- 5.8 hours and the patients left the ICU after 2.2 +/- 3.2 days. Oral intake was allowed after a mean of 2.6 +/- 2.9 days and the central venous lines were removed after 3.8 +/- 3.9 days. The administration of analgetic drugs was required for 2.9 +/- 3.9 days. The mean length of stay in the hospital was 9.6 +/- 5.5 days. CONCLUSIONS: Laparoscopic aortobifemoral bypass grafting is feasible in a selected group of patients. Despite relatively long operation times and the use of a pneumoperitoneum, we did not encounter significant cardiopulmonary adverse effects.

[Laparoscopic aortic surgery in a swine model using a newly designed intestine retraction system]. / Laparoskopische Aortenchirurgie am Schweinemodell unter Zuhilfenahme neuentwickelter Darm-Retraktionssysteme.

BACKGROUND: Recently, the feasibility of laparoscopic surgery for aortic occlusive and aneurysmal disease has been demonstrated in clinical studies. However, aortic access is compromised by poor exposure of the operative field from uncontrolled bowel. Currently available retractors are inadequate. The development of new retracting instruments therefore may facilitate laparoscopic aortic surgery. METHODS: Two paddles inserted in a polyester bilayer (mobile device, group A) or a mesh net fixed to the abdominal wall (fixed device, group B) were used to retain the bowel. Six female piglets (28-30 kg) in each group underwent laparoscopic aortic surgery. RESULTS: Mean time to deploy the device was 22 +/- 12 min in group A and 36 +/- 34 min in group B (n.s.). Vascular surgery time averaged 60 +/- 24 min in group A and 68 +/- 16 min in group B (n.s.), the time to withdraw the nets was respectively 3.6 +/- 1.2 min and 13.5 +/- 8.2 min (p < 0.05). Total surgery time was 155 +/- 41 min vs. 174 +/- 49 min (n.s.). Two retraction failures have been registered (1 in group A and 1 in group B). No major complications were documented. CONCLUSIONS: Both nets provided adequate exposure of the infrarenal aorta. Vascular surgery time and blood loss were similar in both groups. Nevertheless, the handling of the mobile device (group A) seemed to be more comfortable in direct comparison. The newly developed retraction devices might facilitate the performance of laparoscopic aortic surgery.