[Retroperitoneal approach to the abdominal aorta for occlusive disease.].

The abdominal aorta can be approached through the peritoneum or retroperitoneally. The aim of this study was to compare these two routes of exposure. Over a 10 year period, between 1979 and 1989, 48 patients were operated on for an aortobifemoral bypass, because of occlusive diseases of aorta or iliac arteries. The retroperitoneal approach was used in 20 cases and 28 were operated by the standard transperitoneal approach. In a non randomized retrospective study the outcome was compared regarding; operation time, blood transfusion during operation, initiation of alimentation, hospitalisation and mortality. All of the patients were operated on by two experienced vascular surgeons. In the retroperitoneal group there were 11 men and 10 women with a mean age of 63,4 years. In the transperitoneal group there were 16 men and 10 women with a mean age of 60,3 years. With the retroperitoneal approach the operating time was 185 min. v. 248 min. for the transperitoneal group (p<0.05). The fasting period after operation was four days for the retroperitoneal group v. five days for the transperitoneal group (p<0.05). The hospitalization was 11 days when the retroperitoneal approach was used v. 15 days for the transperitoneal group (ns). The results of this study indicate that it is advantageous to approach the abdominal aorta through a retroperitoneal route.

[Surgery for abdominal aortic aneurysm. What is an acceptable complications rate?]. / Kirurgi for abdominale aortaaneurismer. Hva er akseptabel komplikasjonsfrekvens?

At the annual meeting of the Vascular Section of the Scandinavian Surgical Society in 1993 it was decided to discuss standards for quality in vascular surgery. This article is discussing operations for abdominal aortic aneurysms with special reference to early mortality and complications like graft infection and aortoenteric fistula. The discussion is based on national vascular registers and investigations on vascular surgical activity in the Scandinavian countries. In addition, a survey of the literature is given. Although these data should be regarded as a guide-line only, we feel that one should try to keep the 30 day mortality following elective resection for asymptomatic abdominal aortic aneurysm below 5-7 per cent. A mortality less than 50-60 per cent following operation for ruptured aneurysm may be regarded as reasonable. Patient-selection regarding age, concomitant disease etc. could significantly influence these results, and should be taken into consideration when comparison between different series is made. Graft infection is a serious complication and if the frequency is higher than 2 per cent, or there is an accumulation of graft infections in a vascular centre, the hospital routines should be reviewed carefully. The occurrence of infection is higher following operations for ruptured aneurysms than following elective operations. Early operations for haemorrhage and early occlusion should be below 5-6 per cent. Some authors have shown a correlation between the volume of operation, postoperative mortality and the frequency of complications. We therefore think that it might be reasonable to suggest that at least patients who have concomitant diseases like serious coronary heart disease or renal insufficiency should be operated on in vascular centres.(ABSTRACT TRUNCATED AT 250 WORDS)

[Vascular surgical operations in Iceland 1984-1988]. / Kärlkirurgiska operationer i Island 1984-1988.

It is 30 years since the first arterial prosthesis surgery was performed in Iceland. During the last five years 1,229 arterial operations were performed in the five largest hospitals in Iceland. This means an average of 245.8 per year, or 98.3 operations per 100,000 inhabitants yearly. The number has increased from 183 in 1984 to 289 in 1988.