SURGICAL APPROACHES TO REVASCULARISATION OF AORTO-ILIACAL SEGMENT

Introduction: The retroperitoneal approach for abdominal aortic and iliac reconstruction classically had been reserved for select patients with either high-risk comorbid disease or specific anatomic problems that preclude the transabdominal approach. With increasing appreciation of the physiologic, anatomic, and technical advantages of the retroperitoneal approach, the authors have expanded its use for repair of all types of aorto-iliac artery disease as well as infected aortic grafts. The objective of this article is to determine whether retroperitoneal approach for aorto-iliac surgery has greater physiologic and technical advantages than transperitoneal approach. Patients and Methods: From January 2002 to May 2006, 344 retroperitoneal aortoiliac reconstructions were performed and 2 for infected aortic grafts. On the other hand we also performed 283 transperitoneal aortic and aorto-iliac reconstructions. From total number of operated patients for aorto-iliac disease, 99 patients fulfilled criteria for entrance in the study. Beside identical operative indication (aorto-iliac disease), patients were matched according to comorbidities, age, gender, and bad habits such as smoking and alcohol abuse. Results: The mean age was 61 years with 70 men and 29 women. Overall mortality was 1% for all cases: 2% for trnasperitoneal and 0% for retroperitoneal approach. Major complications occurred in 11% of all procedures, 8% in retroperitoneal and 14% in transperitoneal approach. Over the past 4.5 years, the average length of hospital stay for uncomplicated aorto-iliac reconstructions was 5.9 days in retroperitoneal group and 6.3 days in transperitoneal group, intensive care unit stay was 1.2 days in retroperitoneal and 2.5 days in transperitoneal group, and diet was resumed by postoperative day 1 in retroperitoneal versus postoperative day 3 in transperitoneal group. Two-year graft patency was 99% for retroperitoneal and 96% for transperitoneal approach. Discussion: The retroperitoneal approach offers greater physiologic advantages than transperitoneal approach, associated with minimal disturbance of gastrointestinal and respiratory function, thereby reducing the length of intensive care unit and hospital stay.