New technological developments played a central part in this year’s VEITHsymposium and in addition to stent grafts, new advances in laparoscopic surgery and graft infection were highlighted.
Dr Yves S Alimi, Head of the Department of Vascular Surgery at the Centre Hospitalo-Universitaire (Marseilles, France), began his presentation by outlining the advantages of the Retis, a laparoscopic intestinal retractor, as compared to conventional laparoscopic surgery. During surgery, the patient is kept in a regular supine position, which significantly helps decrease the risks of lung collapse and cerebral edema typically associated with longstanding declivous position
In addition, the Retis permits surgeons to use the same approach to the aorta as in open surgery, leading to a decrease in patient time spent on the table. The device also reduces peritoneal pressure, allowing the free circulation of blood to other vital organs, thus reducing the risk of damage to them during the procedure.
Alimi also discussed the SuDyn, a laparoscopic semi-automated knot-tying device for thread sutures. To perform laparoscopic aorto-prosthetic anastomosis, the hard staples and clips can be damaging, especially to fragile or heavily calcified aortas. However, hand-tying tiny knots is tremendously difficult even for the most skilled vascular surgeons. The SuDyn better enables surgeons to do precise work in fragile aortas, helping to halt bleeding while simultaneously decreasing the amount of clamping required.
Following Alimi, Dr Ralf Kolvenbach, Department of Vascular Surgery and Endovascular Therapy, Augusta Hospital (Duesseldorf, Germany) reported his preliminary clinical experience using the laparoscopic aortic stapler. Like the SuDyn, the stapler works to reduce the amount of clamping time needed during surgery.
Kolvenbach’s study examined the outcomes for 15 patients who underwent a mini-laparotomy using the aortic stapler. The average period of time until the aortic clamp could be released was only four minutes, a considerable reduction to the clamping time required by conventional surgery. Post-operative computer tomography scanning of all 15 patients demonstrated that the staples helped secure the stents used during the procedures without incident. This preliminary experience suggests that aortic stapling is a safe and effective minimally invasive procedure.
There were also additional presentations focused on novel and successful methods of reducing the incidence of post-operative vascular graft infection. Graft infection generally occurs in only 1% to 2% of all procedures, but is often life-threatening.
Dr Dieter O Mayer, Vascular Surgeon at the Zurich University Hospital and Head of Would Care at the Clinic for Cardiovascular Surgery (Zurich, Switzerland), presented the findings of a four-year study involving the use of a vacuum-assisted closure system (V.A.C, developed by Kinetic Concepts) to treat graft infections, also known as V.A.C.-on-Vessel treatment. The device involves the controlled application of negative pressure to help permit better wound drainage and generally promote wound healing.
In Mayer’s study, 39 patients with 47 vascular infection sites had the V.A.C. system directly applied to the various sites of infection, including blood vessels and grafts, areas usually advised for direct vacuum therapy. The results were impressive: the technical success rate was 100%; no vascular erosion, bleeding, or thrombosis related to the V.A.C. system occurred; at 30 days post-operative, there was 0% mortality; and at 24 months post-operative, only one graft had to be removed due to occlusion and ongoing infection.
“Since its introduction about four years ago, VAC-on-Vessel treatment has lead to a paradigm shift in the treatment of abdominal and peripheral vascular and graft infections at the Zurich University Hospital,” commented Mayer. In the majority of patients, complex medical and surgical therapies with high morbidity and mortality have been replaced by clear-cut and simple algorithms with a low morbidity and mortality rate. Quality of life during VAC-on-Vessel treatment is substantially enhanced when compared to classic radical regimens.”
Finally, Dr Max Zegelman, Professor of Surgery and Head of Vascular and Thoracic Surgery at Krankenhaus Nordwest (Frankfurt, Germany) presented his study of the use of a new metallic silver-impregnated graft (Silver Graft, developed by B Braun/Aesculap) in vascular surgery. The Silver Graft is a polyester prosthesis that has been vaporized with silver, which has been confirmed by long-term studies to have a bactericidal effect. Zegelman was able to chart the outcomes of the first six-month of the use of Silver Grafts a vascular prosthetics. In the 50 cases he studied, there were no incidents of infection. Additionally, the Silver Graft was able to halt infection when placed in three patients previously infected during procedures that used conventional vascular grafts.
Of the technological developments, Zegelman said, “Both the V.A.C.-on-Vessel and Silver Graft show promise as safe, effective therapies for eliminating potentially deadly post-operative infection as a complication of vascular graft surgery.”