Minimally invasive endovascular surgery

Compared to open surgery, Endovascular repair is minimal invasive. Hollywood, no holidays we can make the endovascular aneurysm repair more minimal invasive.
Through the utilization all minimal evasive operator techniques Such as intravenous sedative anesthesia, Percutaneous access technique, Minimal contrast administration and Simplified operative planning, We are able to operate on the patient and discharge the patient is the same day.
In our organization, EVAR for most AAAs IS PERFORMED AS A DAILY SURGERY IN ROUTINE.

less invasive revascularization

This is a case I have completed today.
A 80 y.o. gentleman ,who suffered from intermittent claudication for a long time. A total occlusion over his left thigh artery was diagnosed. From the angiography above, you can see there is a block on the artery which makes the distal artery lack of blood flow. Since the smptoms getting worse day by day, he was suggested to have a "revascularization".
In the old days, we surgeons tend to do "open bypass" which means insertion of a artifical tube into the leg to drain the blood from healthy arteries to distal artery. Usually the bypass surgery needs to cut multiple wounds on the leg and to make tunnels in the leg to insert the artifical artery. Sure the procedure is a painfula and lengthy procedure with relatively painful recovery course.
Nowadays we adopt the so call "endovascular revascularization". Like in this case, we have just stick a tiny hole on the thigh (without even using a blade!) and insert some king of balloon catheter into the artery. We have found the blockage under X ray and open the blockage by balloon. No cutting or sutures on the artery needed. No painful tunneling in the flesh needed. The recovery course will be very easy to the patient and he will be able to walk a couple of hours later.

Thanks to the endovascualr technique, we can render more effective treatments to patients with artery diseases in a less invasive fashion.

the minimal invasive surgery on aorta disease

In the past , surgery on aorta disease remains to be one of the major procedures in the realm of vascular surgery . The mortality and morbidity remains to be the major concern of those patients suffered from the disease. Thanks to the advance of the medical technology, nowadays we are able to treat lots of aorta dissease in a less invasive fashion. The invention of arotic stentgrafting (endovascualr treatment; EVAR or TEVAR) makes the procedure more safe and less painful for the patients.
Finally, the stentgraft are available in Taiwan sinced 2005. And in our hospital, we vascular surgeons soon adopted the new technique to treat our patients. We can now treat a giant thoracic aneurysm or abdominal aneurysm through tiny holes in the patients groin area!
more information about our institution for those who live abroad: internatinal service center of CGMH

the sequence of treatment for DM foot

I received a call today from our plastic surgeon. One of his inpatients was diagnosed to be a DM foot with foot ulcers. He had perated on the foot for several times to debride the necrotic tissue. According to his statement, the perfusion of those tissue were not so good. And the condition of the soft tissue got worsen after each debridement. He thus than arranged noninvasive study and image study which revealed that there is a total occlusion over the patient's femoral artery! No wonder that the lesion did not get better after debridement!
He had then call me for the possibility of revascularization.

Sure, revasclarization is a must for the tissue perfussion which is the fundamental element of wound healing. The problem is , the sequence (or priority) of treatment was obviously wrong!

From the viewpoint of a vascular surgeon, we should do as follows for a DM foot with ischemic compoment.

1. Infection control or minor debridment of the infected tissue
2. Revascularization , either PTA or bypass
3. Debridement or amputation to facilitate wound healing
4. Reconstruction, if needed

It's a pity that our physicion, let alone those patient, nearly always think about the vascular condition to late. They did not pay attention to their vascular condition. They may miss the chance of the optimal treatment.

My point is, vascular condition is the most fundamental. We have to keep in mind the diagnosis of ischemic leg.

popliteal total occlusion: bypass with Distaflo!

History
A patient of chronic ischemic leg presented with right side gangrene toes. Image study showed right side popliteal artery total occlusion. Revascularization was thus indicated.
Op finding
The right side above knoww popliteal artery was explored to be severe calcified and severe diseased. Endarterectomy was done. The below knee popliteal artery was then explored.
Operation Strategy
PTA alone was note considered because of longer patency was expected. Due to the location of the total occlusion(just behind the knee joing), PTA with stentgrafting was not considered. A Distaflo (cuffed ePTFE graft was implanted as a bypass graft. You can see the cuff of the graft was nicely seated on the target vessel.

case: FP bypass using Distaflo graft

Today, a patient of PAOD (peripheral artery occlusive disease) who was discharged from the hospital some 10 days ago came back to the clinic for his posoperative check. Here is his postoperative images.
History
He was a victim of right femoral artery total occlusion presented with severe intermittent claudiction. a right side femoro-popliteal bypass had been performed in some other hospital around half a year ago. unfortunately, the graft failed almost immediately after the procedure and the symptom had never been treated. (Here you can see the previous inserted graft, which is occluded already) He thus then came to my institution for further help.
Operative finding
severe atheromatous change of CFA, right side was noted during the procedure. I have used a ePTFE graft which has a cuffed design (Distaflo, BARD) for the bypass graft. the target vessel was the below knee popliteal artery. The postoperative image showed here a patent graft with beautiful distal anastomosis. The cuffed shape of the arterial anastomosis had been showed clearly and beautifully. The flared cuff design of the graft, compare to the regular graft, can enhance the artery blood flow and decrease the possible turbulance blood flow over the anastomosis thus in turn decrease the future intimal hyperplasia on the vessel wall. Theoretically, it can prolong the distal bypass graft patency.

The patient had been rather well after the surgery. No more claudication was complained.
I sure hope that the cuffed design of the graft can minimize the possible stenosis in the future!