Related Experiment Video
Updated: Jul 29, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Minimal incision aortic surgery
W D Turnipseed1, S C Carr, G Tefera
1University of Wisconsin Medical School, Department of Surgery, Section of Vascular Surgery, Madison WI, 53792, USA.
Purpose:
In this study we evaluated the clinical and economic impact of minimal incision aortic surgery (MIAS) for treatment of patients with abdominal aortic aneurysms (AAAs) and aortoiliac occlusive disease (AIOD).
Method:
Fifty patients with either AAA (34) or AIOD (16), prospectively treated with the MIAS technique, were compared with 50 patients (40 AAA and 10 AIOD) treated in the same time period with long midline incision and extracavitary small bowel retraction. MIAS was also compared with a cohort of 32 patients with AAA treated by means of endoaortic stent-grafts. Outcomes and cost (based on metric mean length of stay) were compared for the open and endoaortic techniques.
Results:
Patients who experienced no perioperative complications after the MIAS or endovascular repair technique had shorter hospital stays than patients with uncomplicated aortic repairs performed with a traditional long midline abdominal incision (3 days vs 3 days vs. 7.2 days). Hospital stay was also significantly shorter for the less invasive procedures when perioperative complications were included (4.8 days vs. 4.3 days vs 9.3 days). The MIAS and endovascular aortic repair groups had a shorter intensive care unit stay (< or = 1.0 day) and a quicker return to general dietary feeding (2.5 days) than patients treated with standard open repair (1.8 days, 4.7 days). The overall morbidity for the MIAS technique (14%) and endovascular technique (21%) was not significantly different from standard open repair (24%). The mortality rate for the different treatment groups was equivalent (MIAS, 2%; endovascular repair, 3%; standard repair, 2%). The MIAS was more cost-efficient than standard open repair ($12,585 vs $18,445) because of shorter intensive care unit and hospital stay and was more cost-efficient than endoaortic repair ($12,585 vs $32,040) because of reduced, direct intraoperative costs.
Conclusions:
MIAS is as safe as standard open or endovascular repair in the treatment of AAA and AIOD. MIAS is more cost-efficient than standard open or endoaortic repair.
Insights
Minimal incision aortic surgery (MIAS) offers a safe and cost-effective alternative for treating abdominal aortic aneurysms (AAAs) and aortoiliac occlusive disease (AIOD), comparable to traditional open or endovascular methods.
Area of Science:
- Vascular Surgery
- Minimally Invasive Procedures
- Health Economics
Background:
- Abdominal aortic aneurysms (AAAs) and aortoiliac occlusive disease (AIOD) are significant vascular conditions.
- Traditional open surgical repair can involve substantial morbidity and cost.
- Minimally invasive aortic surgery (MIAS) aims to reduce surgical trauma and improve patient outcomes.
Purpose of the Study:
- To evaluate the clinical and economic impact of MIAS for AAA and AIOD.
- To compare MIAS outcomes and costs against standard open repair and endovascular stent-grafts.
Main Methods:
- Prospective study comparing 50 MIAS patients with 50 standard open repair patients and 32 endovascular repair patients.
- Outcomes assessed included perioperative complications, hospital stay, ICU stay, and return to diet.
- Economic analysis focused on cost-efficiency, primarily driven by length of stay and intraoperative expenses.
Main Results:
- MIAS and endovascular repair demonstrated shorter hospital and ICU stays compared to standard open repair, both with and without complications.
- Overall morbidity and mortality rates were comparable across MIAS, endovascular, and standard open repair groups.
- MIAS proved more cost-efficient than both standard open repair and endovascular repair, mainly due to reduced hospital stay and direct costs.
Conclusions:
- MIAS is a safe and effective treatment option for AAA and AIOD, with clinical outcomes similar to standard open and endovascular repairs.
- MIAS presents a more cost-efficient approach compared to both standard open and endovascular aortic repair strategies.
