Combined aortorenal reconstruction: is there an optimum method of exposure?

To determine the advantages and disadvantages of two different transabdominal approaches to expose the pararenal aorta; infacolic (IC) and medical visceral rotation (MVR).

Retrospective study.

We reviewed a consecutive series of concurrently treated patients undergoing combined aortorenal reconstruction using one of these two approaches (IC n = 45; MVR n = 30).

The two groups were identical with respect to demographics, risk factors and associated illnesses. Aortic aneurysmal disease predominated among MVR patients, and occlusive disease among IC patients (p = 0.001). The most common aortic reconstruction was aortofemoral bypass grafting. Renal revascularisation was most often performed for symptoms; only in the MVR group it was the result of involvement by aortic aneurysmal disease (p = 0.000). Thromboendarterectomy was the most common renal reconstruction, though performed only 10 times in the MVR group (p = 0.01). Except for supraceliac aortic cross-clamping, which was required more often in the MVR group (p = 0.004), operative details did not differ between the groups. Although the overall perioperative mortality and complication rate were equal, intraoperative splenic injury occurred solely in the MVR group (p = 0.001), and these patients experienced more pulmonary complications (p = 0.004) and they were hospitalised longer than the IC group (29.7 +/- 35.8 vs. 17.2 +/- 15.4 days; p = 0.04).

MVR has increased morbidity, but its unrestricted continuous exposure is optimum for combined aortorenal reconstruction involving pararenal aneurysmal disease. Pararenal occlusive disease is adequately exposed in most cases by the IC approach.