CURRENT STATUS OF THE USE OF RETROPERITONEAL APPROACH FOR RECONSTRUCTIONS OF THE AORTA AND ITS BRANCHES

Objective The objective of this article is to determine whether retrop eritoneal approach for aortic surgery has certain physiologic, technic al advantages. Summary Background Data The retroperitoneal approach fo r abdominal aortic reconstruction classically had been reserved for se lect patients with either high-risk comorbid disease or specific anato mic problems that preclude the transabdominal approach. With increasin g appreciation of the physiologic, anatomic, and technical advantages of the extended posterolateral retroperitoneal approach, the authors h ave expanded its use for repair of all types of aortic visceral and re nal artery disease as well as ruptured abdominal aortic aneurysm and i nfected aortic grafts. Methods From January 1981 to September 1995, 23 40 retroperitoneal aortoiliac reconstructions were performed in 2243 p atients. Aortic reconstructions accounted for 1756 cases: 1109 for ele ctive abdominal aortic aneurysms, 210 for ruptured and symptomatic aor tic aneurysms, 399 for occlusive disease, 18 for infected aortic graft s, and 20 for other indications. Iliofemoral disease was the indicatio n for 584 procedures. As experience was gained, this approach also was used for 417 renal and 50 celiac and superior mesenteric artery recon structions. Conclusions The retroperitoneal approach offers certain ph ysiologic advantages associated with minimal disturbance of gastrointe stinal and respiratory function, thereby reducing the length of intens ive care unit and hospital stay. in addition, its technical advantages and flexibility facilitates visceral and juxtarenal aortic reconstruc tions without the need for thoracotomy.