Open Retroperitoneal Repair for Complex Abdominal Aortic Aneurysms.

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.