Aortic surgery and laparoscopy: still a future in the endovascular surgery era?


COD: 02_2017_01_2586 Categorie: ,

Pierfrancesco Veroux, Vincenzo Ardita, Alessia Giaquinta, Alberto Davì, Giusi Basile, Massimiliano Veroux

Ann. Ital. Chir., 2017 88, 2: 97-104

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Laparoscopic surgery (LS) is the minimally invasive alternative to open surgery and endovascular approach for treating
major aortic diseases. Only few reports in the literature describe the long-term outcomes of the laparoscopic approach for
major vascular diseases. Furthermore, the widespread use of endovascular techniques has limited the use of LS to wellselected
patients. This review evaluated the results of LS for aortic disease and compared the clinical outcomes of laparoscopic
technique with those of open and endovascular surgery. A systematic review was performed by using the MEDLINE
database, along with a meta-analysis of the reported studies on the treatment of abdominal aortic aneurysm (AAA)
and/or aorto-iliac occlusive disease (AIOD). Forty-three studies were analyzed (17 for AAA and 26 for AIOD), with a
total of 1197 patients with AAA and 1307 patients with AIOD. Laparoscopic surgery, when performed in experienced
centers, is a feasible and safe technique for the treatment of AAA and AIOD in patients unfit for open and endovascular
repair. Assisted laparoscopic approach has shown better outcomes than totally laparoscopic repair, with a lower rate
of mortality and morbidity. Endovascular repair, however, remains the gold standard in the treatment of AAA.