The retroperitoneal approach to the abdominal aorta in the endovascular era

• Published in: Journal of vascular surgery 2012-09, Vol.56 (3), p.834-838
• Main Authors: Twine, Christopher P., MD, FRCS, Lane, Ian F., MD, FRCS, Williams, Ian M., MD, FRCS
• Format: Article
• Language: English
• Subjects: Aorta, Abdominal - surgery; Aortic Aneurysm, Abdominal - history; Aortic Aneurysm, Abdominal - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - history; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Clinical Competence; Diseases of the aorta; Endovascular Procedures - adverse effects; Endovascular Procedures - history; Evidence-Based Medicine; History, 20th Century; History, 21st Century; Humans; Learning Curve; Medical sciences; Peritoneum - surgery; Retroperitoneal Space - surgery; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2012.04.021

The aim of this review was to assess the place of retroperitoneal (RP) aortic surgery for abdominal aortic aneurysms ( AAAs ) in the endovascular era and evaluate the evidence supporting it in preference to the more traditional transperitoneal approach. As endovascular graft technology improves, open aortic surgery is declining. AAAs unsuitable for endovascular aneurysm repair are, by definition, anatomically challenging. The RP approach is especially suited to anatomic challenges such as those posed by contemporary open AAA because it facilitates access to the suprarenal aorta. There is evidence that the RP approach reduces postoperative morbidity and length of stay compared with transperitoneal approaches. The evidence available indicates that the RP approach should be the first considered for any AAA unsuitable for endovascular aneurysm repair; however, the technique is more difficult to learn and less commonly practiced than the transperitoneal approach. Combined with a decrease in training hours in the United Kingdom, there is a real threat that the RP technique will only be performed by an ever-decreasing number of enthusiasts.