COMBINED AORTORENAL RECONSTRUCTION - IS THERE AN OPTIMUM METHOD OF EXPOSURE

Objective: To determine the advantages and disadvantages of two differ ent transabdominal approaches to expose the pararenal aorta, infracoli c (IC) and medical visceral rotation (MVR). Design: Retrospective stud y. Methods: We reviewed a consecutive series of concurrently treated p atients undergoing combined aortorenal reconstruction using one of the se two approaches (IC n = 45; MVR n = 30). Results: The two groups wer e identical with respect to demographics, risk factors and associated illnesses. Aortic aneurysmal disease predominated among MVR patients, and occlusive disease among IC patients (p = 0.001). The most common a ortic reconstruction was aortofemoral bypass grafting. Renal revascula risation was most often performed for symptoms; only in the MVR group it was the result of involvement by aortic aneurysmal disease (p=0.000 ). Thromboendarterectomy was the most common renal reconstruction, tho ugh performed only 10 times in the MVR group (p=0.01). Except for supr aceliac aortic cross-clamping, which was required more often in the MV R group (p = 0.004), operative details did not differ between the grou ps. Although the overall perioperative mortality and complication rate were equal, intraoperative splenic injury occurred solely in the MVR group (p=0.001), and these patients experienced more pulmonary complic ations (p=0.004) and they were hospitalised longer than the IC group ( 29.7+/-35.8 vs. 17.2+/-25.4 days: p=0.04). Conclusions: MVR has increa sed morbidity, but its unrestricted continuous exposure is optimum for combined aortorenal reconstruction involving pararenal aneurysmal dis ease. Pararenal occlusive disease is adequately exposed in most cases by the IC approach.