title: The retroperitoneal approach combined with epidural anesthesia reduces morbidity in elective infrarenal aortic aneurysm repair.
abstract: In elective open infrarenal aortic aneurysm repair the surgical approach and the use of epidural anesthesia (EDA) may determine patients' outcome. Hence we analyzed our results after elective open aneurysm repair in the light of the surgical approach and the use of EDA. Retrospective analysis of a prospective data base. From December 2005 to April 2008, 125 patients with infrarenal aortic aneurysm underwent elective open repair. Patients were divided into four groups: retro- and transperitoneal approach with and without epidural anesthesia (RP+/-EDA and TP+/-EDA). In terms of age, sex, aneurysm diameter, ASA score and clamping time all groups were comparable. In the retroperitoneal groups significantly more tube grafts were implanted (63 vs. 27; P=0.001). The rate of surgical complications did not differ between the groups. The RP+EDA group had the lowest rate of postoperative assisted mechanical ventilation (5.1% vs. 35.7%; P=0.002) and medical complications (17.9% vs. 42.8%; P=0.032). Concerning frequency of surgical complications, the retroperitoneal incision was comparable to the transperitoneal approach in infrarenal aortic reconstruction. Supplementation with EDA resulted in a decreased rate of postoperative assisted mechanical ventilation and in lower morbidity rates.
authors.affiliation: Department of Thoracic and Vascular Surgery, University of Ulm, Ulm, Germany. bernd.muehling@uniklinik-ulm.de
authors.forename: Bernd M
authors.initials: BM
authors.lastname: Muehling
authors.forename: Rainer
authors.initials: R
authors.lastname: Meierhenrich
authors.forename: Matthias
authors.initials: M
authors.lastname: Thiere
authors.forename: Gisela
authors.initials: G
authors.lastname: Bischoff
authors.forename: Alexander
authors.initials: A
authors.lastname: Oberhuber
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Orend
authors.forename: Ludger
authors.initials: L
authors.lastname: Sunder-Plassmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D001014:Aortic Aneurysm / Q000601:surgery*; D001803:Blood Transfusion; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010537:Peritoneum / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D012121:Respiration, Artificial; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome