Aortobifemoral bypass via paramedian incision and retroperitoneal approach for aortoiliac occlusive disease.

INTRODUCTION: Aorto-bifemoral graft bypass operation is performed in the surgical treatment of aortoiliac occlusive occlusive disease. The conventional standard technique used is the median laparotomy and transperitoneal approach. In this study we evaluated the outcome of aortobifemoral bypass operation via paramedian and retroperitoneal approach. METHODS: 17 patients were operated upon for aortobiiliac occlusive disease from January 2008 through December 2011. Mean age of the patients was 61.8 +/- 8.9 (47-78 years). All patients except for one were operated via left paramedian vertical 8 to 10 cm incision approximately 6 cm to the left or right of midline, extending from a few centimeters above the umbilicus to just above the symphysis pubis. The aortas were reached retroperitoneally through this incision. RESULTS: There was one postoperative death secondary to pulmonary complications. No intraoperative or postoperative surgical complication had occured. All patients were discharged from the hospital on antiplatelet therapy. Graft patency was evaluated by means of physical examination on discharge. Upon the patients' hospital discharge, primary graft patency was 100%. The ankle-brachial indices measured from both the right and left sides were 0.51 +/- 0.10 preoperatively and 0.99 +/- 0.14 postoperatively (p <0.001). DISCUSSION: A lot of complications can be observed due to median laparotomy such as evisceration, incisional hernia, peritonitis, bride ileus. We believe that retroperitoneal approach for aorto-bifemoral graft bypass operation in the patients with bilateral iliac arterial occlusive disease is a well tolerated minimally invasive operation when compared to the conventional median laparotomy approach.

Surgical treatment of cardiogenic shock due to huge right atrial thromboembolus.

An unusual case is reported of thromboembolus in the right atrium associated with cardiogenic shock and multiple pulmonary micro-embolisms. Two-dimensional echocardiograpy demonstrated a large irregular mass in the right atrium floating freely, prolapsing through the tricuspid valve into the right ventricle during diastole, and leading to inflow and outflow obstruction. An emergency operation was performed and the thromboembolic material was successfully extracted from the right atrium without using cardiopulmonary bypass. This exemplary case highlights the benefit of surgical intervention rather than more conservative approaches such as anticoagulation and/or thrombolysis.

Protective effects of trimetazidine in transient spinal cord ischemia.

The neuroprotective effect of trimetazidine (TMZ) was tested prospectively in a rabbit spinal cord ischemia model. Ischemia was induced by clamping the aorta just distal to the left renal artery and proximal aortic bifurcation for 20 min. Twenty-five male New Zealand white rabbits were randomized as follows: TMZ group (n=100) receiving 3 mg/kg trimetazidine intravenously before the occlusion of the aorta; control group undergoing occlusion but receiving no pharmacologic intervention (n=10); sham-operation group (n=5) subjected to operative dissections without aortic occlusion. Physiological parameters and somatosensory evoked potentials (SEP) were monitored in animals before the ischemia, during the ischemia and in the 1st, 15th and 60th min of reperfusion. Neurologic status was assessed 24 and 48 h after the operation. The spinal cord, abdominal aorta, and its branches were processed for histopathologic examinations 48 h after the operation. At the end of the ischemic period, the average N1-P1 amplitude was reduced to 22% of the baseline in all ischemic animals. This was followed by a gradual return to 90+/-2% of the initial amplitude in the TMZ group and 81+/-2% in the control group (P<0.05) after 60 min of reperfusion. The average motor function score was significantly higher in the TMZ group than the control group (3.7+/-0.5 vs 3.1+/-0.6 at 24 and 3.5+/-0.7 vs 2.9+/-0.6 at 48 h; P<0.05). Histologic observations were clearly correlated with the neurologic findings. The results suggest that trimetazidine reduces spinal cord injury during thoracoabdominal aortic operations and may have therapeutic utility during high risk operations.