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CC BY 4.0 · Aorta (Stamford) 2022; 10(05): 225-234
DOI: 10.1055/s-0042-1749173
Original Research Article

Retroperitoneal Compared to Transperitoneal Approach for Open Abdominal Aortic Aneurysm Repair Is Associated with Reduced Systemic Inflammation and Postoperative Morbidity

Damian M. Bailey 
1   Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
,
George A. Rose 
1   Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
,
Daniel O'Donovan
2   Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
,
Dafydd Locker
3   Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
,
Ian R. Appadurai
2   Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
,
Richard G. Davies
1   Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
2   Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
,
Richard J. Whiston
3   Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
,
Mohamad Bashir 
1   Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
3   Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
,
Michael H. Lewis
1   Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
,
Ian M. Williams 
1   Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
3   Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
› Author Affiliations Funding D.M.B. is supported by a Royal Society Wolfson Research Fellowship (grant no.: WM170007), Royal Society International Exchanges Award (IES\R2\192137), Japan Society for the Promotion of Science (#JSPS/OF317), and funding from the Higher Education Funding Council for Wales for G.A.R.
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Abstract

Background In the United Kingdom, the most common surgical approach for repair of open abdominal aortic aneurysms (AAAs) is transperitoneal (TP). However, retroperitoneal (RP) approach is favored in those with more complex vascular anatomy often requiring a cross-clamp on the aorta superior to the renal arteries. This study compared these approaches in patients matched on all major demographic, comorbid, anatomic, and physiological variables.

Methods Fifty-seven patients (TP: n = 24; RP: n = 33) unsuitable for endovascular aneurysm repair underwent preoperative cardiopulmonary exercise testing prior to open AAA repair. The surgical approach undertaken was dictated by individual surgeon preference. Postoperative mortality, complications, and length of hospital stay (LoS) were recorded. Patients were further stratified according to infrarenal (IR) or suprarenal/supraceliac (SR/SC) surgical clamping. Systemic inflammation (C-reactive protein) and renal function (serum creatinine and estimated glomerular filtration rate) were recorded.

Results Twenty-three (96%) of TP patients only required an IR clamp compared with 12 (36%) in the RP group. Postoperative systemic inflammation was lower in RP patients (p = 0.002 vs. TP) and fewer reported pulmonary/gastrointestinal complications whereas renal impairment was more marked in those receiving SR/SC clamps (p < 0.001 vs. IR clamp). RP patients were defined by lower LoS (p = 0.001), while mid-/long-term mortality was low/comparable with TP, resulting in considerable cost savings.

Conclusion Despite the demands of more complicated vascular anatomy, the clinical and economic benefits highlighted by these findings justify the more routine adoption of the RP approach for complex AAA repair.

Keywords

abdominal aortic aneurysm repair - retroperitoneal - transperitoneal - cardiorespiratory fitness - inflammation

On behalf of the Cardiovascular Network for Wales (DM Bailey) and South-East Wales Vascular Network (all authors).




Publication History

Received: 16 February 2021

Accepted: 18 February 2022

Article published online:
20 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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