Extraperitoneal approach for aortoiliac reconstruction of the abdominal aorta

Peck, James J.; McReynolds, Donley G.; Baker, David H.; Eastman, A. Brent

doi:10.1016/0002-9610(86)90571-4

Cited by 31 publications

(11 citation statements)

References 6 publications

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“…23-25 Leather et al (n=299) demonstrated a reduction of pulmonary complications and length of stay favorable for the retroperitoneal approach. 23 Peck et al (n=270) also showed a shorter length of stay with the retroperitoneal approach and less complications including pneumonia, the need for nasogastric suction, and atelectasis in the retroperitoneal group.…”

Section: Discussionmentioning

confidence: 99%

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Transperitoneal versus retroperitoneal approach for open abdominal aortic aneurysm repair in the targeted vascular National Surgical Quality Improvement Program

Buck

Ultee

Zettervall

et al. 2016

Journal of Vascular Surgery

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Objective We sought to compare current practices in patient selection and 30-day outcomes for transperitoneal and retroperitoneal AAA repairs. Methods All patients undergoing elective transperitoneal or retroperitoneal surgical repair for AAA between January 2011 and December 2013 were identified in the Targeted Vascular NSQIP database. Emergent cases were excluded. Baseline characteristics, anatomical detail, intra-operative and post-operative outcomes were evaluated among those with infrarenal or juxtarenal AAA only. Results 1,135 patients were identified; 788 transperitoneal (69%), 347 retroperitoneal (31%). Evaluating infrarenal and juxtarenal aneurysms only, the retroperitoneal patients were less likely to have an infrarenal clamp location (43% vs. 68%), had more renal revascularizations (15% vs. 6%, p<.001), more visceral revascularizations (5.6% vs. 2.4%, p=0.014) and more lower extremity revascularizations (11% vs. 7%, p=0.021) compared to the transperitoneal approach. Post-operatively there were no differences in mortality, or return to OR. Transperitoneal patients had a higher rate of wound dehiscence (2.4% vs. 0.4%, p=0.045), while retroperitoneal patients had higher incidence of pneumonia (9% vs 5%, p=0.034), transfusions (77% vs. 71%, p=0.037), reintubations (11% vs. 7%, p=0.034) and a longer LOS (median 8 vs. 7 days, p=0.048). After exclusion of all concomitant procedures, only transfusions remained more common in the retroperitoneal approach (78% vs. 70%, p=0.036). Multivariable analyses showed only higher rates of reintubation in the retroperitoneal group (OR1.7, 95% CI 1.0-3.0, p=0.047). Conclusions The retroperitoneal approach is more commonly used for more proximal aneurysms and was associated with higher rates of pneumonia, reintubations, transfusions and a greater length of stay on univariate analyses. However, multivariable analysis demonstrated similar results between groups. The long-term benefits and frequency of reinterventions remain to be proven.

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Section: Discussionmentioning

confidence: 99%

“…They did not demonstrate significant differences in wound infections or post-op myocardial infarctions. 25 Sicard et al (n=213) showed that the retroperitoneal approach was preferable with respect to blood loss. 24 …”

Section: Discussionmentioning

confidence: 99%

Transperitoneal versus retroperitoneal approach for open abdominal aortic aneurysm repair in the targeted vascular National Surgical Quality Improvement Program

Buck

Ultee

Zettervall

et al. 2016

Journal of Vascular Surgery

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“…This mostly concerns elderly patients who are at high anaesthetic risk. The incidence of incisional hernia does not differ between a transperitoneal or retroperitoneal approach5, 6. Even after mesh repair of the incisional hernia, there is a further recurrence rate of up to 30 per cent7, 8.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of vertical or transverse laparotomy for abdominal aortic aneurysm repair

Fassiadis

Hennig

et al. 2005

British Journal of Surgery

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“…A transperitoneal access was used because we had significant previous experience with this approach. However, retroperitoneal access to the abdominal aorta has recently become accepted in our department and is now routinely employed; this was not the case at the beginning of this study 22,23 . Wylie´s (1952) ring endarterectomy technique was employed.…”

Section: Discussionmentioning

confidence: 98%

Aortofemoral thromboendarterectomy

et al. 2002

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PURPOSE:To study whether endarterectomy is feasible in all patients with aortofemoral atherosclerotic obstruction, considering early and late results.METHODS: A clinical, prospective, and descriptive study carried out in a university hospital. Inclusion criteria were atherosclerotic aortofemoral obstructive disease, clinical status compatible with major surgery, and absence of prior restorative procedure. Exclusion criteria were aneurysm, inflammatory arterial disease, and prior restorative procedure found during surgery. Eighty patients entered the protocol, but 9 were excluded (11.2%). Seventy-one patients, mean age of 57.3 years, underwent endarterectomy. Operative indications were intermittent claudication and critical ischemia. A ring-stripper endarterectomy technique was employed in all patients. Results were related to age, gender, symptoms, presence of diabetes mellitus, extension of endarterectomy, and extent of obstructive disease. Chi square or Fisher exact tests were used when appropriate, and the Wilkoxon (Gehan) test was used to compare survival curves.RESULTS: Sixty-eight (100%) endarterectomies were patent at discharge. The mortality rate was 4.2%. The amputation rate (4.3%) was higher in diabetic patients and when there was associated femoropopliteal obstruction. The 5-year survival rate was 83.3%, and late deaths were mostly cardiovascular. Diabetes mellitus, age above 65 years, and associated femoropopliteal obstruction lowered the survival rate. The 5-year patency rate was 87.0%. Critical ischemia and less extensive endarterectomies were associated with a lower patency rate. There were no anastomotic aneurysms or deep infections.CONCLUSIONS: Aortofemoral thromboendarterectomy is feasible in 90% of patients, early mortality rate is low, diabetic patients and those with associated femoropopliteal obstructive disease have a higher mortality rate, amputation rate is low, late deaths are mostly cardiovascular, and late patency rate is high, and even higher in the intermittent claudication group.

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Extraperitoneal approach for aortoiliac reconstruction of the abdominal aorta

Cited by 31 publications

References 6 publications

Transperitoneal versus retroperitoneal approach for open abdominal aortic aneurysm repair in the targeted vascular National Surgical Quality Improvement Program

Transperitoneal versus retroperitoneal approach for open abdominal aortic aneurysm repair in the targeted vascular National Surgical Quality Improvement Program

Randomized clinical trial of vertical or transverse laparotomy for abdominal aortic aneurysm repair

Aortofemoral thromboendarterectomy

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