Open Surgery of the Visceral Aorta by Purely Abdominal Approach

Abstract

Listen

Translate article

Introduction: Despite the development of endovascular techniques, open surgery keeps indications in the treatment of juxta or pararenal abdominal aortic aneurysms (AAA). We have developed an original, retroperitoneal, pararectal approach, allowing access to the visceral aorta as well as both iliac bifurcations, without phrenotomy nor thoracotomy. We report here the results of a continuous and consecutive monocentric experience. Methods: From January 2013 to December 2017, the data of all the patients who underwent open surgery for elective AAA with clamping of at least one visceral artery (n=46) were collected prospectively. The approach was in all cases a retroperitoneal, pararectal, left prerenal laparotomy giving access to visceral arteries and iliac bifurcations. Results: These aneurysms, close to or involving the visceral aorta represented 19% of the AAA operated during the same period (n = 244). Patients were male in 89% of cases, with a mean age of 71 years, an average body mass index of 27.0 ± 4.2, and an obesity rate of 26%. Chronic renal failure was present in 40%, chronic occlusive pulmonary disease in 17.4% and hostile abdomen in 17.4% of the cases. The average diameter of the aneurysm was 62 ± 16 mm. The clamping concerned the suprarenal, supra-mesenteric or celiac in 71.8%, 10.8% and 17.4% of cases, respectively. The renal, superior mesenteric and celiac clamping durations were 36 ± 19 min, 31 ± 19 min, and 27 ± 13 min, respectively. The average duration of the surgical procedure was 204 ± 73 minutes with an average blood loss of 1873 ± 1313 ml. The in-hospital mortality rate was 4.3% (n = 2). The post-operative complications were transient acute renal failure (41.3%), without any chronic dialysis, surgical revisions for bleeding (6.5%), postoperative pneumonia (4.3%) and one cholestasis with hepatic cytolysis. During a 35.6 ± 16.5 months follow-up, we observed 1 case of incisional hernia (2.2%), 2 cases of parietal atomia (4.3%) and no vascular complication. Five patients (10.9%) died during the follow-up of unrelated causes. Conclusion: In this short series, this purely abdominal approach demonstrated its interest in open AAA surgery extended to the visceral aorta with low mortality and morbidity, at short and long term. Disclosure: Nothing to disclose