Dr R K Mishra
INTRODUCTION:
Aortoiliac occlusive disorder arises when your iliac arteries come to be tapered or obstructed. The aorta is the main artery of the body, dissociates into parts at almost the range of your abdomen button. These parts or branches are known as the iliac arteries. The iliac arteries go through your pelvis into your legs, where they cleave into several tiny arteries which run down to your toes. Aortoiliac disease is thought as a kind of peripheral arterial disease (PAD) because it influences arteries, that are blood vessels that take blood far from your heart to your limbs.
The arteries are usually efficient and unhindered on the inside, but with the passage of time, a tacky compound known as plaque can boost up in the walls of arteries. Plaque is comprises of cholesterol, calcium, and fibrous tissue. As high the plaque boost up, it triggers the arteries to tapered and congeal. This method is known as atherosclerosis,or stiffen of the arteries. Ultimately, sufficient plaque boosts up to interrupt with blood circulation in your iliac arteries or leg arteries. This disease called aortoiliac occlusive disease because it associates the aortoiliac arteries.
When your iliac arteries tapered or become plugged, your legs may not perceive the blood and oxygen they require. This deficiency of oxygen is known as ischemia and it can trigger pain. In serious cases, sores or gangrene can produced, which can conclude in dropping a limb. Although, these developments are not common except the technique is not cured and is permitted to carry on.
Symptoms:
Aortoiliac disease may progress if it is left untreated. Indications that it has enhanced containing:
- Severe pain, coldness, and numbness in a limb
- Sores on your toes, heels, or lower legs
- Dry, scaly, cracked skin on your foot. Major cracks, or fissures, may become infected if left untreated
- Weakened muscles in your legs
- Gangrene (tissue death), which may require amputation
If you feel any of these progressive indications, it frequently means that your leg arteries are inhibited or obstructed in more than one place.
Causes of aortoiliac occlusive disease:
Atherosclerosis, or hardening of the arteries, triggers most cases of aortoiliac occlusive disease.
Risk factors for hardening of the arteries comprises of:
- Smoking
- High cholesterol levels in the blood
- High blood pressure
- Obesity
- Having a family history of heart disease
AORTO-ILIAC LAPAROSCOPY TECHNIQUE:
At the commencing, laparoscopy for aorto-iliac disease based on the previous instrumentation created for local surgery. Betterments in instrumentation all along in the mid 1990s made it possible to firmly catch laparoscopically a huge vessel and carry out a totally laparoscopic anastomosis. Today, the laparoscopic technique has transformed into the identification of a new minimally invasive technique.
Laparoscopy in vascular surgery, just as in local surgery, gynecology, or urology, has shown essential clinical advantages compared with open surgery. It has been explained that this minimally invasive approach has less mortality rates that is shorter stay at hospital; lower postoperative pain; rapid return to a usual diet, constitutions, and work; lower incisional hernia rates; as well as improve cosmetic outcomes. It has the extra benefits of reproducing the quality and durability of the open technique. The most challenging technique is the totally laparoscopic technique. Efforts are recently being done to assist the progress of the technique by accomodating a quite simpler and rapid process of vascular anastomosis. Moreover, as with any other technique, the learning curve is estimated to be about 25 cases to 30 cases for the laparoscopic-assisted approach.
Complications:
Complications observed are categorized as either surgery related or medical. An over all complication rate of 14.5% was observed. The most usual surgery concerned complications are acute limb ischemia followed by graft thrombosis (5.4%) and ischemic colitis. The most predominant medical complications are pneumonia (12.9%) followed by renal failure (8.3%) and myocardial infarction.
Conclusion:
Over the years, signs for laparoscopic surgery have augment and contraindications reduced. Even type IV thoraco-abdominal aneurysms and juxtarenal aneurysms have been cured. It is expected that in the future, with progressive knowledge of vascular laparoscopy and better instrumentation, morbidity and mortality rates will decrease. Total laparoscopic aortic bypass is feasible. In patients with TASC C and D aortoiliac occlusive lesions, short-term outcomes are comparable to those with conventional aortic bypass. After the initial learning curve, laparoscopic technique may reduce the operative trauma of aortic bypass.
World Laparoscopy Hospital, Cyber City, DLF Phase II, Gurugram, NCR Delhi, 122 002, India
PHONES:
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