The retroperitoneal approach for abdominal aortic aneurysms.

Graft replacement has become the reliable and effective form of treatment for abdominal aortic aneurysms (AAA). Operative therapy remains the major undertaking with significant rates of postoperative morbidity and mortality. The use of retroperitoneal approach has been proposed as an alternative to standard midline transabdominal approach. Over a 5 year period, 43 consecutive nonrandomized infrarenal AAA patients underwent elective surgical correction by the authors. 32 patients with the mean age of 75 underwent transabdominal reconstructive procedures for AAA. The average size of AAA was 5.9 cm and operative time was 3 hours and 25 minutes. The mortality rate was 6.25 per cent (2 of 32). The cause of death was myocardial infarction 1, and acute renal failure 1. There are many complications in the transabdominal group. 11 had prolonged ileus, 2 MI, 2 wound dehiscence, 2 atelectasis, 1 acute renal failure and 1 chylous ascites. In 11 patients with retroperitoneal approach, the average size of AAA was 5.6 cm and operative time was 3 hours and 29 minutes. No operative mortality, the only 1 complication was retroperitoneal hematoma. The most notable difference between the retroperitoneal group and transabdominal group was the speed and ease of postoperative recovery. The patients in the retroperitoneal group needed a shorter period of intubation, nasogastric drainage, stay in the intensive care unit and hospital. Patients in the retroperitoneal group also resumed oral alimentation sooner, shorter and smoother postoperative course. The patients in the retroperitoneal group had less blood loss and fewer transfusions than in the transabdominal group. Findings from our experience using the left retroperitoneal approach for a reconstructive procedure of AAA indicate that it results in fewer overall physiologic disturbances of the patients. We believe that the left retroperitoneal approach is a useful surgical access of choice for the elective repair of AAA.

A simple tunneler for extra-anatomical bypass grafts and interposition arteriovenous hemodialysis fistulas.

A simple and inexpensive tunneler has been employed in arterial grafting encompassing femoropopliteal, aortofemoral, axillo femoral bypass and vascular access procedures. This is fashioned from a disposable Argyle thoracostomy tube. This technique is recommended because of its simplicity, ready availability, lack of expense, and relative safety.