[The approach to the infradiaphragmatic and adrenal aorta]

The progressive selection of the patient reserved to open surgery is determined by the preference of the endovascular option on the treatment of abdominal aortic aneurysm. This fact probably will cause a reduction of the number of cases singularly approachable by the infrarenal way while will prevail the need of control and clamping of the infradiaphragmatic and adrenal aorta. The approach to the infradiaphragmatic and adrenal aorta introduces technical and physiopathologic problems related to the hold interconnection between the vessel and the surrounding structures, particularly those visceral. The choice of the approach is determined by the surgical gesture that is had to perform. The simple supraceliac aortic clamping or the wrapping of bypass on the visceral arteries can be made by an anterior approach, supramesocolic transperitoneal, while the correction of an juxtarenal or adrenal aneurysm can be performed by a submesocolic approach. The extraperitoneal approach offers a complete vision of this part of aorta, without the pancreas or left renal veins interposition, but it allows a bad control of the iliac and right renal arteries. The surgeon has to have familiarity with both the approaches, to be able to perform his own intervention in the simplest and effective way.