The Extended Retroperitoneal Approach for Treatment of Abdominal Aortic Aneurysms

(Division of Cardiovascular Surgery, Department of Surgery, Mitsui Memorial Hospital, Tokyo, Japan)

Ikutaro Kigawa Sachito Fukuda Yoichi Yamashita
Yasuhiko Wanibuchi
From July 1984 to June 1998, 159 patients with infrarenal abdominal aortic aneurysms (AAA) were surgically treated in our hospital by the extended retroperitoneal (ERP) approach described by Williams et al. There were 132 men and 27 women, with a mean age of 69.3 years. Of the 159 patients, 82 (52%) had hypertension, 62 (39%) had coronary artery disease, of which 20 cases had previously received coronary artery bypass grafting, 17 (11%) had diabetes, 16 (10%) had thoracic aortic disease, 15 (9.4%) had cerebrovascular disease, and 14 (8.8%) had chronic renal dysfunction, including 6 cases on hemodialysis. Among these patients treated with this approach, 67 cases underwent tube grafting and 92 received Y-grafting. Patent inferior mesenteric arteries were ligated in all cases except one. Postoperative morbidity was observed in 54 cases (34%); lower extremity ischemia including microembolism or acute graft occlusion in 13, abdominal complication including paralytic ileus, liver dysfunction, or gastrointestinal hemorrhage in 11, wound complication in 9, pulmonary in 7, cardiac in 6, cerebral in 4, and the others in 4. No patient suffered ischemic colitis. There was hospital mortality in 4 cases (2.5%). Two patients died because of myonephropathic metabolic syndrome on second postoperative day. Two patients with combinations of several co-existing diseases died because of respiratory failure or multi-organ failure on the 48th and 141st postoperative day. Oral feeding was restarted at a mean of 2.7 days after the operation, and 64% of the cases did not require blood products. The mean postoperative hospital stay of survivors was 16.9 days (range, 7-63 days). Based on our clinical experience, we believe that the ERP approach is a safe and useful procedure for elective surgery for AAA to enable fast recovery and short hospital stay, especially in older and high-risk patients.
@Jpn. J. Cardiovasc. Surg. 30: 7-10 (2001)