Endarterectomy of the upper abdominal aorta and visceral arteries through an extraperitoneal approach

Surgical access to the upper abdominal aorta and renal arteries remains technically difficult. We describe a retroperitoneal approach to the suprarenal aorta and renal arteries through the left flank. Using this approach, which is exclusively infradiaphragmatic, we have operated on 11 patients with complex occlusive lesions of the renal arteries and upper abdominal aorta. This technique has been associated with no patient death and a minimal morbidity rate in our experience thus far. The advantages of the approach are shortened operative time, ease of exposure and postoperative decrease in ileus and respiratory complications. Use of this technique facilitates surgical treatment of patients with occlusive disease of the upper abdominal aorta and its branches.