title: Left flank retroperitoneal exposure: a technical aid to complex aortic reconstruction.
abstract: Over the last 5 years an extended left flank retroperitoneal approach was used in 85 of 531 (16%) aortic reconstructions deemed technically complex. Abdominal aortic aneurysm repair was performed in 70 patients (82%), bypass of aortoiliac occlusive disease was performed in 11 (13%), and aortic endarterectomy for mesenteric and/or renovascular disease was performed in 4 (5%). Indications for use of this approach included a "hostile" abdomen (43 patients), juxta/suprarenal abdominal aortic aneurysm (35), large (greater than 10 cm) abdominal aortic aneurysm (12), extreme obesity (10), associated renal and/or visceral artery stenosis requiring endarterectomy (9), inflammatory abdominal aortic aneurysm (2), and horseshoe kidney (2). Suprarenal or supraceliac aortic clamping, averaging 31 minutes, was required in 43 patients (50%). Postoperative recovery was rapid (average length of stay, 10.2 days), and morbidity was minimal despite the complex nature of these reconstructions. The perioperative mortality rate in elective operations was 1.2%. This approach facilitated proximal abdominal aortic exposure and anastomosis, especially in large, pararenal aneurysms or in situations unfavorable to a transabdominal approach. Whereas a left flank retroperitoneal approach can be used in most aortic reconstructions, it seems especially suited to those that pose significant technical challenges.
authors.affiliation: Henry Ford Hospital, Department of Surgery, Detroit, MI 48202.
authors.forename: A D
authors.initials: AD
authors.lastname: Shepard
authors.forename: D F
authors.initials: DF
authors.lastname: Tollefson
authors.forename: D J
authors.initials: DJ
authors.lastname: Reddy
authors.forename: J R
authors.initials: JR
authors.lastname: Evans
authors.forename: J P
authors.initials: JP
authors.lastname: Elliott
authors.forename: R F
authors.initials: RF
authors.lastname: Smith
authors.forename: C B
authors.initials: CB
authors.lastname: Ernst
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000009:Abdominal Muscles / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000473:pathology / Q000601:surgery; D001014:Aortic Aneurysm / Q000473:pathology / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery; D003250:Constriction; D004691:Endarterectomy; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D008297:Male; D008638:Mesenteric Arteries / Q000601:surgery; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D012077:Renal Artery / Q000601:surgery; D012086:Reoperation; D012187:Retroperitoneal Space; D012272:Ribs / Q000601:surgery