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 retroperitoneal approach for aortic surgery has certain physiologic, technical advantages. Summary Background Data The retroperitoneal approach for abdominal aortic reconstruction classically had been reserved for select patients with either high-risk comorbid disease or specific anatomic problems that preclude the transabdominal approach. With increasing appreciation of the physiologic, anatomic, and technical advantages of the extended posterolateral retroperitoneal approach, the authors have expanded its use for repair of all types of aortic visceral and renal artery disease as well as ruptured abdominal aortic aneurysm and infected aortic grafts. Methods From January 1981 to September 1995, 2340 retroperitoneal aortoiliac reconstructions were performed in 2243 patients. Aortic reconstructions accounted for 1756 cases: 1109 for elective abdominal aortic aneurysms, 210 for ruptured and symptomatic aortic aneurysms, 399 for occlusive disease, 18 for infected aortic grafts, and 20 for other indications. Iliofemoral disease was the indication for 584 procedures. As experience was gained, this approach also was used for 417 renal and 50 celiac and superior mesenteric artery reconstructions. Conclusions The retroperitoneal approach offers certain physiologic advantages associated with minimal disturbance of gastrointestinal and respiratory function, thereby reducing the length of intensive care unit and hospital stay. in addition, its technical advantages and flexibility facilitates visceral and juxtarenal aortic reconstructions without the need for thoracotomy.