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Open Retroperitoneal Repair for Complex Abdominal Aortic Aneurysms.

Martin Hossack1,2, Gregory Simpson1, Penelope Shaw1

  • 1Liverpool Vascular and Endovascular Service, Royal Liverpool and Broadgreen University Hospitals National Health Service Trust, Liverpool, United Kingdom.

Aorta (Stamford, Conn.)
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Open surgical repair (OSR) of complex abdominal aortic aneurysms (CAAAs) via retroperitoneal (RP) approach is safe and effective. This method treats more complex disease with similar outcomes to transperitoneal (TP) repair.

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Area of Science:

  • Vascular Surgery
  • Aortic Aneurysm Repair
  • Surgical Outcomes

Background:

  • Open surgical repair (OSR) of complex abdominal aortic aneurysms (CAAAs) presents significant surgical challenges.
  • The retroperitoneal (RP) approach is frequently employed for these complex cases.
  • Auditing outcomes is crucial to establish the utility and safety of the RP approach for CAAAs.

Purpose of the Study:

  • To audit the outcomes of open surgical repair (OSR) for complex abdominal aortic aneurysms (CAAAs) using the retroperitoneal (RP) approach.
  • To establish the safety and utility of the RP approach in treating CAAAs.
  • To compare outcomes of RP repair with the transperitoneal (TP) approach for context.

Main Methods:

  • Retrospective analysis of patients undergoing OSR for unruptured CAAAs via RP approach over 7 years.
  • Collection of demographic, operative, radiological, and biochemical data.
  • Comparison with data from transperitoneal (TP) repairs; primary outcome: 30-day/inpatient mortality; secondary outcomes: reoperation, chest infection, acute kidney injury (AKI), and length of stay (LOS).

Main Results:

  • 103 patients underwent OSR (55 RP, 48 TP).
  • RP group had more advanced disease (larger diameter, more proximal extent) and higher supravisceral clamping rates (66% vs. 15%).
  • No significant differences in 30-day mortality, reoperation rates, chest infection, AKI, or length of stay between RP and TP groups.

Conclusions:

  • Open surgical repair of CAAAs has significant 30-day mortality.
  • Both RP and TP approaches are viable for OSR in patients unsuitable for endovascular repair.
  • RP repair allows treatment of more advanced CAAAs with complex clamping zones, demonstrating similar perioperative morbidity and mortality compared to TP repair.