ABSTRACT
The past several decades have witnessed a marked improvement in the treatment results for a variety of vascular lesions. The operative mortality for elective repair of aortic aneurysms has decreased from 21% in early surgical series to less than 5% in recent studies.[1-5] Lower extremity occlusive disease with ischemic tissue loss which at one time mandated major amputation can now be treated by either interventional techniques, bypass surgery, or a combination of the two with favorable limb salvage rates.[6] Finally, despite advances in the delivery of emergency medical services and in critical care medicine, major arterial injury secondary to penetrating or blunt trauma has remained a challenging problem, especially when central arteries such as the aorta, the iliacs, or the subclavian arteries are involved.[7-9]
Despite these improvements in the management of vascular lesions, significant perioperative morbidity and mortality still occur, particularly in cases associated with severe comorbid medical illness, scarring from previous operations, or multiorgan trauma.[10-13] Even in good-risk patients, standard vascular repairs have associated morbidity. Additionally, standard surgical treatment adversely impacts quality-of-life measures such as incisional pain and paresthesias, sexual dysfunction, and other problems. Finally, lengthy hospital stays are a major contributing factor to rising health care costs. These problems are at least in part related to the large incisions and extensive tissue dissection required for surgical access to major arterial lesions.
