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Retroperitoneal approach to the aorta.

T F O'Donnell1

  • 1Tufts University School of Medicine, Boston, Massachusetts.

Surgical Technology International
|May 8, 2015
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Summary
This summary is machine-generated.

The retroperitoneal approach for aortic surgery, though seemingly new, is an old technique revived for its lower morbidity and mortality. This historical surgical method is effective for complex aortic reconstructions and abdominal aortic aneurysms (AAA).

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Area of Science:

  • Vascular Surgery
  • Surgical History
  • Aortic Aneurysm Repair

Background:

  • The retroperitoneal approach for aortic surgery has a long historical precedent, dating back to the early 1800s.
  • Interest in this surgical method has resurfaced due to its reported benefits in reducing patient morbidity and mortality.
  • Historical accounts and recent series highlight the efficacy of the retroperitoneal approach for various aortic conditions.

Purpose of the Study:

  • To review the historical evolution and re-emergence of the retroperitoneal approach in aortic surgery.
  • To emphasize the benefits of the retroperitoneal approach, including lower morbidity and mortality rates.
  • To highlight its application in complex aortic reconstructions and abdominal aortic aneurysms (AAA).

Main Methods:

  • Historical review of surgical literature and case series detailing the retroperitoneal approach for aortic procedures.
  • Analysis of reported outcomes, including mortality and morbidity, from various historical and contemporary studies.
  • Description of surgical techniques, such as medial rotation of the kidney for posterior aortic access.

Main Results:

  • Early reports by Cooper and Dulsost demonstrate the historical use of the retroperitoneal approach for iliac and abdominal aortic aneurysms.
  • Studies by Rob (1963) and Helsby et al. (1975) reported low mortality rates (3%) for aortoiliac reconstruction using this approach.
  • Recent work by Williams and subsequent series by Leather and Sicard show low mortality (4%) and morbidity for complex aortic reconstructions and AAA repair, with shortened hospital stays.

Conclusions:

  • The retroperitoneal approach is a historically validated and effective surgical strategy for aortic surgery.
  • Its re-adoption is supported by evidence of reduced mortality, morbidity, and hospital stay, particularly for high-risk patients and complex cases.
  • This approach offers a viable alternative for abdominal aortic aneurysm (AAA) repair and aortoiliac reconstruction.