IF08. Results of a New Retroperitoneal Approach for Abdominal Aortic Aneurysm Repair

Abstract

Despite the progress of endovascular repair, open surgical repair still holds a position in the treatment of abdominal aortic aneurysms (AAA). We developed an original, retroperitoneal, pararectal approach, allowing both access to iliac bifurcations and visceral aorta. We report herein the Results of this technique. From January 2013 to December 2017, 244 patients with an asymptomatic AAA underwent open surgical repair in our center. All data were prospectively collected in a database. The surgical approach was retroperitoneal with a left pararectal laparotomy. The incision, following the reflection line between the rectus abdominus and the oblique abdominal muscles, allows access to the visceral arteries as well as the iliac arteries bifurcations without the need for a phrenotomy or a thoracotomy (Figs 1 and 2). Two hundred forty-four patients with a mean age of 71 ± 10 years were entered in the study. Among those, 94.2% were male, 30.6% were obese (body mass index, >30), 22.1% presented with chronic renal failure, 17.5% with chronic obstructive pulmonary disease, and 16.7% with hostile abdomen. The AAA was pararenal or suprarenal in 26.6% of cases. The respective diameters of the AAA, left and right iliac arteries were 56.7 ± 11.4 mm, 16.4 ± 8.0 mm, and 18.4 ± 9.9 mm. The level of aortic cross-clamping was inter-renal, suprarenal, supramesenteric, or celiac in 4.8%, 16.2%, 1.7%, and 3.1%,respectively. The renal, superior mesenteric and celiac clamping times were 36 ± 19 minutes, 31 ± 19 minutes, and 27 ± 13 minutes, respectively. The postoperative mortality rate at 30 days was 1.6%. The main complication was acute kidney failure (14.7%), including stage 3 Acute Kidney Injury Network/Kidney Disease: Improving Global Outcomes in 4.5%, but no patient went on chronic dialysis. Postoperative pneumonia occurred in 3.3%, myocardial infarction in 0.8%, atrial fibrillation in 1.2%, evisceration in 0.8%, and pulmonary embolism in 0.4%. A surgical revision was needed in 4.9% of the patients. Median length of hospital stay was 7 days. During a median follow-up of 38 ± 16 months, we observed 15 incisional hernias (6.1%) and 13 bulges of the abdominal wall (5.3%). Twenty-four patients (9.8%) died during the follow-up. This original approach, which allows access to the visceral aorta by a unique abdominal incision without the need for a phrenotomy or a thoracotomy, has shown excellent Results in treating patients with all types of AAA.Fig 2This surgical approach allows access to the visceral arteries as well as the iliac arteries bifurcations without the need for a phrenotomy or a thoracotomy. CT, LRA, left renal artery; LRV, left renal vein; SMA, superior mesenteric artery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)