“Mini cut” - Atherosclerosis of abdominal aorta

1.

“Mini cut” –Atherosclerosis
of abdominal aorta
A special surgical approach

2.

• OBSTRUCTIVE ARTERIAL DISEASES IS A SEVERE WIDESPREADED
DISEASE AMONG PEOPLE AND DIFFICULT TO TREAT ( SURGICAL
NOSOLOGY )DESPITE OF MODERN LEVEL OF PHARMACOLOGY AND
DEVELOPMENT OF INTERVASCULAR METHODS OF TREATMENTS
ATHEROSCLEROSIS OF LOWER EXTREMETIES DEMANDS BIG OPEN
SURGERIES ..
• THE MOST DIFFICULT TO TEAT IS A ATHEROSCLEROTIC PATHOLOGY OF
INFRARENAL AORTA AND ILLIACA ARTERIES AND WITH SESVER
PROLOANGATED OCCLUSION HAS TROBORECTOMY AND
ENDARTORECTOMY DOSENT WORK ONLY WAY OF HELPING THE
PATIENT WITH THIS CONDITION IS BYPASSING OR SHUTING SUCH AS
AORTA FEMORAL BILATERAL OR EPSILATERAL BIPASS

3.

4.

• THESE OPERATIONS ARE CONNECTED WITH SEVERE BLOOD LOSS ,
GREAT OPERATIVE TRAUMA AND OTHER DIFFICULT COMPLICATIONS .
TO HAVE A GOOD SURGICAL APPROACH TO INFRA RENAL VISCERAL
AORTA CLASSICAL SURGERY TELLS US TO DO TOTAL LAPATOMY AND
THAT’S WHAT WE WERE THOUGHT FOR AGES BY OUR FORFATHERS
.BUT IN THE UNIVERSITY CLINIC WE TRY TO BREAK THIS TRADITION
AND DEVELOP A NEW MINI SURGICAL APPROCH WITH VISCERAL
AORTA . THAT’S WHAT THIS PRESENTATION IS ABOUT .

5.

• WE ANALYSED 40 PATIENTS MEDICAL DOCUMENTS AND WE FOUND THE
FOLLOWING ,
• IN THE SURGICAL DEPARTMENT OF UNIVERSITY CLINIC FROM JULY 2019 TO NOV
2023 ( 4 YEARS ) IT WAS DONE 21( AORTA BYPASS OPERATION WITH TOTAL
LAPRATOMY AND 18 MEN . THE PATIENTS USSING NEW METHOD OF SURGICAL
PROCEDURE ( SUPRA UMBLICAL APPROACH )
• 21 TRADITIONAL 18 MAN AND 3 WOMEN FROM 50 TO 81 YEARS OLD 6 HAD
DIABETIES 17 HAD CARDIOISCHEMIA AND 16 HAD ARTERIAL HYPERTENSION AND
6 HAD ISCHEMIA OF BRAIN 18 ARE THOSE WHO HAD HABIT OF SMOKING .
• 15 MAN AND 3 WOMEN FROM 65 TO 83 YEARS OLD 3 WITH DIABETIES 15 WITH
AERTERAIL HYPERTENSION AND CARDIAC ISCHEIA 2 HAD BRAIN ISCHEMIA

6.

• In first group there was 7 bilateral aorta bypass and 14 unilateral or
epsilateral operations . all of these patients had severe prolongated
aorticsclerotic occlusion of aorta illeaca segments
• 5 patienys from traditional group got thrombosis and were giving
experimental method for 2nd time and became members of 2nd grp
• In experimental grp 9 were bi and 9 were unilateral . TEADITIONAL
METHOD IS A TOTAL LAPROTOMY FROM XYPHOID PROCESS TO PUBIC
SYMPHYSIS ALONG THE MID LINE SURROUNDING HALF WAY AROUND
UMBLICUS .

7.

• MINI APPROACH IS 7 TO 8 CM ABOVE UMBLICUS. SURGICAL APPROCH ON
FEMORAL ARTERY WAS COMMON IN BOTH GROUPS ABOVE THE LINE OF
KHENS LINE ( 10 CM ).
• FOR MINI APPROCH WE USE NARROW AND LONG RETRACTORS
• FOR THE BYPASS WE USE PTFT ARTIFICAL PROSTHETIC BYPASS MADE IN
RUSSIA AND NAMED ‘ECOFLON ‘FOR THE BILATERAL BYPASSES IT WAS
20MM FOR AORTA , 10MM FOR DISTAL ANATOMOSES AND 8 MM FOR
UNILATERAL BYPASS
• WE USED 2-0 PROLINE STRING TAPPERING NEEDLE 5-O AND 6-0 FOR
DISTAL ANASTOMSES .

8.

• IN THE FIRST GROUP ALL THE OPERATIONS WERE PRIMARY ( 1ST TIME
)
• FOR 2ND GROUP 9 OPERATIONS WERE SECONDARY BECAUSE OF THIS
MINI WAY OF APPROACH THE 2NDARY OPERATIONS ARE BETTER
BECAUSE THERE IS NO FIBROSIS SOFT AORTA NO ATHEROMA
• TABLE OR DIAGRAM . 5 PATIENTS OF THESE 9 ARE FROM 1ST GROUP
BECAYSE OF ATHEROTHROMBOSIS

9.

• RESULTS AND OUTCOMES :
• THE MAIN IDEA OF OUR INVESTION WAAS TO COMPARE DURATION OF OPERATION , DURATION OF POST OPERATION CARE IN
REANIMATION AND IN SURGICAL UNIT , FREQUENCY OF POST OPERATIVE COMPLICATIONS , USE OF ANALGISICS AFTER POST
OPERATION ,
• WHT WE FOUNF ABOUT THE DURATION OF OPERATION IS THAT ONE SIDE BYPASS FROM FEMORAL ARTERY USUALLY TAKES FROM
3 HRS AND 20 MINS TO 4 HRS . WHEN IT IS LLAPROTOMY IT TAKES 2 AND HALF TO 3 HRS WITH MINI SURGICAL APPROACH .
• BILAYERAL AORTA BYPASSS TAKES 4 AND HALF TO 5 HRS WITH TOTAL LAPROTOMY AND LESSS THAT 4 HRS IN MINI SURGICAL
APPROACH . ALL Ptients in the traditional group spend 2 or 3 days in reanimation unit with epidural catheter with need of heavy
pain killer drugs such as tremadol , promedol and sebason all patients from the experimental group spend 1 day in reanimation
unit only with epidural catheter and with pain killer such as diclofinac and catheralac the duration if total hospitalization is 14 days
in avg in traditional group and 7 days in experimental group .
• One of the patient in traditional group died on the second day because of heart failure , in experimental group there were no
deathes noted till now . we did the telephone call to all the patients and found out 3 patients with traditional group had umbilical
venteral herenia after 6 , 9 and 14 months after operation , there was no postoperative herenias with experimental methods .

10.

• CONCLUSIONS :
• 1. ATHEROSCLEROSIS OCCLUSIONS OF AORTA AND ILLEACA ARTERIES IS
STILL NEEDS BIG OPEN APPROACHES WHICH REQIUIRES A LONG TERM
REQUIRE FOR PATIENTS WITH LOT OF ANALGESIS , POST OPERATIVE
MANAGEMENT AND HUGE FINACIAL EXPENDITURE FOR PATIENT AND
CLINIC ALSO COMES WITH LOT OF POST OPERATIVE COMPLICATIONS
WHILE MINI SURGICAL APPROAH TO AORTA IS A GOOD METHOD FOR
2NDARY RECONSTRUCTION , IT ALSO PROMISES WITH LESS HOSPITAL SAT
ECOMICAL AND COST EFFECTIVE ALONG WITH LESS POST OPERATIVE
COMPLICATIONS AS THE AREA OF APPROACH IS MINIMISED .
• FINALLY TO CONCLUDE WE CAN SAY THAT SUPRA UMBLICAL APPROACH TO
AORTA IS SOME WHAT CONCREAT AND LESS COMPLICATRED COMPARED
TO RISK BENEFIT RATIO OF PATIENT STILL IT NEEDS MORE RESEARCH FOR
FURTHER DEVELOPMENT AND BETTERMENT OF THE PATIENYS