Ureteric complications and left retroperitoneal abdominal aortic surgery

Area of Science:

• Vascular Surgery
• Abdominal Aortic Aneurysm Repair
• Surgical Complications

Background:

• The standard open surgery for abdominal aortic aneurysms in the UK uses a midline transperitoneal incision.
• The left retroperitoneal (RP) approach offers potential benefits for juxtarenal aneurysms and specific physiological conditions.
• A key concern with the RP approach is the potential for injury to the renal tract and ureter during kidney mobilization.

Purpose of the Study:

• To investigate the incidence, presentation, and management of left renal tract complications after open aortic surgery using the RP approach.
• To analyze the reasons for choosing open surgery over endovascular repair.
• To examine the relationship between aortic cross-clamp positions, reconstruction types, and ureteric complications.

Main Methods:

• Retrospective analysis of 208 patients who underwent RP aortic surgery for aneurysmal disease.
• Documentation of reasons for open versus endovascular repair.
• Examination of aortic cross-clamp positions and reconstruction techniques.

Main Results:

• Ureteric complications occurred in 2% (4/208) of patients, exclusively in the upper third of the left ureter.
• Symptom onset ranged from 2 to 14 days post-operatively (median 3.5 days).
• Clinical signs were non-specific, including fever, rapid heart rate, and flank pain.

Conclusions:

• Ureteric complications following left RP aortic surgery are infrequent and typically involve the upper ureter.
• Trauma is the most common cause of these complications.
• Ureteric ischemia is a less common cause, presenting later, especially in patients with comorbidities.