ObjectivesTo present the long-term results using total and assisted laparoscopic aortic surgery in arteriosclerotic occlusive lesions and an aneurysm in the aortic-iliac region. Material and methodmethodsA prospective study was conducted by analysing the data of 7 and 14 patients (a total of 21) operated on using aortoiliofemoral bypass from November 2001 to October 2003, and from May 2006 to September 2008, respectively. The lesions consisted of Transatlantic Inter-Society Consensus (TASC) II Type D lesions, and Fontaine stage II, III, and IV lesions, and one abdominal aortic (AAA) lesion, with 11 cases totally laparoscopic and 10 assisted. In the first period, a retroperitoneal approach was used, and in the second, transperitoneal. ResultsOf the 21 patients with a mean age of 60 years (range 41-76), 20 were males and one was female. The mean operating time was 390min (range 222 to 570min). The mean time using an aortic clamp was 110min. There was no perioperative mortality, and the major complications were: one perioperative acute myocardial infarction (AMI), one duodenal perforation, one aortic stitch haemorrhage, and branch thrombectomy at 12hours. The complications at follow-up included: one prosthesis infection (resolved by aortic ligature and axillo-bifemoral bypass. Further surgery was performed on one graft thrombosis due to plication at 5 months, 2 branch thrombectomies and a profundoplasty at 7 months and 10 years, respectively, and one bifurcated bypass replacement at 2 years, with all of them continuing to smoke. There were 5 deaths at 4, 5, 6, 7, and 10 years, with only one associated with its disease. In 2013, 16 patients are alive, with 100% patency. ConclusionsThe difficulty of this surgery and the learning curve, can lead to major complications in the immediate post-operative period. The assisted patency results in the long-term are similar to the excellent results of open surgery.