VIDEOENDOSCOPIC THORACIC AORTA-TO-FEMORAL ARTERY BYPASS - A FEASIBILITY STUDY IN A CANINE MODEL

Purpose: This study was undertaken to determine whether videoendoscopi c thoracic aorta-to-femoral artery bypass is a technically feasible op eration. Methods: An acute canine study involving five mongrel dogs wa s carried out. After the dogs had been given a general anesthetic, the femoral arteries were exposed in the traditional fashion. On the left side, a retroperitoneal, retrorenal tunnel was extended from the comm on femoral artery to the diaphragm. Under videoendoscopic control, the tunnel was opened through the posterior thoracic attachments of the d iaphragm into the thoracic cavity. A Dacron graft was tunneled from th e thoracic cavity on the left to the left groin. The thoracic aorta wa s controlled with a side-biting clamp, and an endo scopically performe d end graft-to-side thoracic aortic anastomosis was created. After com pletion of the thoracic anastomosis, the left femoral anastomosis was created in a traditional manner. A left-to-right femoral bypass comple ted the lower extremity vascular procedure. An open thoracotomy was av oided. Results: Videoendoscopic thoracic aorta-to-femoral artery bypas s was successfully performed in all five animals. All components of th e thoracic procedure, including exposure, dissection, vessel control, cross-clamping, and anastomosis, mere performed through the thoracic p orts with conventional laparoscopic instruments. Blood loss was minima l. All animals survived the procedure before being killed. Conclusion: Videoendoscopic thoracic aorta-to-femoral artery bypass is a technica lly feasible operation in a canine model. Advantages of this unique ap proach over the experimental laparoscopic and the traditional transper itoneal open aortofemoral bypass include ease of aortic exposure, abil ity to control a segment of disease-free aorta, and anastomosis in a d isease-free segment of aorta, Potential advantages include decreased p erioperative morbidity rates with the videoendoscopic approach. Before there is clinical consideration of this surgical approach, long-term experiments are required to demonstrate the safety of the procedure.