The advantage of the thoraco-retroperitoneal approach for aortorenal bypass grafting

Postoperative angiographic studies after aortorenal saphenous vein bypass grafting have revealed a high incidence of graft dilatation and aneurysms. The aortorenal bypasses in all these series were performed via the transabdominal approach which gives an angle of at least 90 degrees between the graft and aorta. The routine approach in the present study has been the thoraco-retroperitoneal one which has been used since more than 20 years in 189 patients. In 13 of them an aortorenal saphenous vein bypass was performed. The saphenous vein was sutured into the aorta above the orifice of the renal artery giving an acute angle of about 45 degrees. This angle gives much more favourable hemodynamic conditions including less turbulence. All the patients survived the operation and were followed for a mean period of 5 years. Two of the patients were hypertensive because of stenosis of the opposite renal artery. Eight patients are normotensive and three patients are improved. Renal arteriograms performed 4 to 13 years postoperatively in five of the patients showed excellent conditions without any dilatation of the graft. The thoraco-retroperitoneal approach gives a very good access to the entire renal artery and permits an aortorenal bypass with an angle which causes a minimum of turbulence.