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A midline retroperitoneal approach for complex abdominal aortic repair: Case description and operative technique.

Authors :
Buckarma E
Beckermann J
Gurrieri C
Frodl B
Saran N
Carmody T
Tallarita T
Source :
Journal of vascular surgery cases and innovative techniques [J Vasc Surg Cases Innov Tech] 2022 Sep 28; Vol. 8 (4), pp. 678-687. Date of Electronic Publication: 2022 Sep 28 (Print Publication: 2022).
Publication Year :
2022

Abstract

In the current endovascular era, open repair of complex aortic aneurysms is becoming a rare, but indispensable, part of vascular surgeons' skill set in specific scenarios. For young, low-risk patients and patients with connective tissue disorders, early target vessel bifurcation, a horseshoe kidney, or pedunculated intraluminal aortic thrombus, fenestrated-branched stent graft technology will not be applicable without significant risks. Thus, an open surgical approach has been recommended for these patients. Most vascular surgeons will be familiar with a transperitoneal approach or a retroperitoneal approach with a lateral incision. For patients with a horseshoe kidney, an inflammatory aneurysm, or a history of multiple intraperitoneal procedures, a retroperitoneal approach should be preferred. In the present report, we have described in detail the optimization of a retroperitoneal approach through a midline incision that provides excellent exposure to the paravisceral aorta, improves exposure to the right renal artery and right iliac artery bifurcation (which is limited using the left flank retroperitoneal approach), and avoids division of the lateral abdominal wall muscles, which has often been associated with iatrogenic muscle denervation and postoperative bulging for four patients who had required complex aortic reconstruction.<br /> (© 2022 The Author(s).)

Details

Language :
English
ISSN :
2468-4287
Volume :
8
Issue :
4
Database :
MEDLINE
Journal :
Journal of vascular surgery cases and innovative techniques
Publication Type :
Academic Journal
Accession number :
36325311
Full Text :
https://doi.org/10.1016/j.jvscit.2022.08.030