Selective use of a right retroperitoneal approach to abdominal aortic aneurysm

The repair of infrarenal abdominal aortic aneurysm by right retroperitoneal dissection using a standard midline transperitoneal incision has previously been described but its clinical application has not been evaluated. Over a 14-year period 144 elective abdominal aortic aneurysm grafts were performed by a single surgical firm. Of these, 11 were carried out by a right retroperitoneal exposure (seven men and four women, aged 63-81 (median 70) years). The indications were to improve access for large juxtarenal aneurysms (n = 6) and because of dense abdominal adhesions (n = 3), horseshoe kidney (n = 1) and retroperitoneal fibrosis (n = 1). In each instance, good proximal control of the aorta was achieved. There were no major operative or postoperative complications and all patients were discharged from hospital (median stay 15 days). Follow-up (median 29 months) has revealed no procedure-related complications.