Retroperitoneal vs transperitoneal approach for nonruptured open conversion after endovascular aneurysm repair

Area of Science:

• Vascular Surgery
• Endovascular Surgery
• Surgical Outcomes Research

Background:

• Transperitoneal (TP) and retroperitoneal (RP) approaches for abdominal aortic aneurysm (AAA) repair have differing outcomes.
• Limited data exists comparing TP and RP approaches specifically for open conversion after endovascular aneurysm repair (EVAR).

Purpose of the Study:

• To evaluate the association between surgical approach (TP vs. RP) and outcomes following open conversion after EVAR.
• To compare perioperative mortality, complications, and long-term mortality between the two approaches.

Main Methods:

• Retrospective analysis of 660 patients undergoing open conversion after EVAR (2010-2022) from the Vascular Quality Initiative.
• Exclusion of ruptured cases; primary outcome: perioperative mortality; secondary outcomes: complications and 5-year mortality.
• Inverse probability weighting and logistic/Cox regression used for risk adjustment.

Main Results:

• RP approach was associated with lower adjusted odds of intestinal ischemia and in-hospital reintervention compared to TP.
• No significant differences in perioperative mortality or 5-year mortality between RP and TP approaches.
• RP approach was more frequently used by high-volume physicians and centers, and for cases with associated renal bypass.

Conclusions:

• The retroperitoneal approach may offer a reduced risk of perioperative complications in open conversion after EVAR.
• Consideration of the RP approach is recommended when feasible for EVAR conversions to potentially improve patient outcomes.