Midline transperitoneal infrapancreatic approach to the supraceliac aorta

Surgical exposure of the paravisceral and supraceliac abdominal aorta through traditional anterior transperitoneal and lateral retroperitoneal approaches are limited by fragmented operative fields and restricted access to right-sided vasculature. We report the technique of a midline transperitoneal infrapancreatic approach to the supraceliac aorta in a 73-year-old man requiring transaortic paravisceral thrombectomy and aortobifemoral bypass grafting for lower-extremity lifestyle-limiting claudication secondary to extensive paravisceral and aortoiliofemoral atherosclerotic disease. Through a midline transperitoneal incision, the pancreas is reflected anterosuperiorly, and dissection is extended cephalad to obtain supraceliac aortic control, thus allowing uninterrupted contiguous exposure of the entire abdominal aorta within a single operative field. This exposure facilitates secure proximal control and complex aortic reconstruction without the need for medial visceral rotation. This technique demonstrates that extension of the infrapancreatic approach to the supraceliac aorta provides continuous aortic exposure while preserving right-sided vascular access and avoiding extensive visceral mobilization, representing a valuable strategy for the management of complex aortic pathology.