Videoendoscopic thoracic aorta-to-femoral artery bypass in the pig

Background. The thoracoscopic approach to the aorta has the advantages of e asy aortic dissection, excellent inflow, improved exposure in the thorax wi thout insufflation, and ability to employ both laparoscopic and traditional instruments. Our aim was to develop a thoracoscopic technique for descendi ng thoracic aorta-to-femoral artery bypass (TAFB) in the pig that results i n acceptable short-term survival and graft patency. Materials and methods. Thoracoscopic TAFB was performed in 11 pigs. Using t wo-lung ventilation, the animals were placed in a 45 degrees left lateral s emidecubitus position. A fan lung retractor, two dissecting ports, intercos tal artery loops, and camera were placed through five 10- to 20-mm thoracos copic incisions. After aortic dissection, an 8-mm graft was passed through a retroperitoneal tunnel. Rumel tourniquets were used for aortic occlusion after placement of a shunt. End-to-side endoscopic anastomosis was complete d with knots tied extracorporeally. The left femoral anastomosis was comple ted under direct vision. Duplex ultrasound of the graft was done on postope rative days 1, 3, and 7. Results. Thoracoscopic TAFB was completed in all animals. Mean aortic anast omosis time was 57 min (range, 34-145); and mean cross-clamp time, 74 min ( range, 53-155). Mean operative time was 310 min; the first six operations l asted longer than the last five (338 min vs 276 min, P < 0.04). Average blo od loss was 611 mi (range, 250-1300). Two animals died due 60 anesthetic co mplications. One (11%) of the nine surviving pigs died on day 2 due to blee ding. Complications were paraplegia in one (11%) and graft thrombosis in an other (11%). Conclusions Videoendoscopic TAFB can be completed in pigs with acceptable s hort-term patency and survival. Further experience in thoracoscopic techniq ues can make TAFB a feasible and low-risk option for selected patients with aortoiliac occlusive disease. (C) 2000 Academic Press.