Laparoscopic remodeling of abdominal aortic aneurysms after endovascular exclusion: a technical description

We report our experience with a novel combined laparoscopic-endovascular procedure to treat endoleaks and graft migration. The operative procedure consisted of the following steps: laparoscopic exposure of the aorta, clipping of lumbar arteries and of the inferior mesenteric artery, incision of the sac of the aneurysm without clamping the aorta, and removal of thrombus material. Laparoscopic sutures were placed externally to attach the endograft to the aortic neck. Laparoscopy was performed a mean interval of 20.2 months after endovascular abdominal aortic aneurysm repair in four cases and immediately after endovascular abdominal aortic aneurysm exclusion in eight consecutive patients. We have yet to prove whether this combined approach is superior to a purely endovascular technique.