title: Retroperitoneal access for abdominal aortic aneurysms: a single center experience.
abstract: BACKGROUND
  Abdominal aortic aneurysms (AAA) may be treated through different surgical techniques. In this endovascular era, surgery remains a mainstay in the management of this disease, especially in patients unsuitable for EVAR. The purpose of this study was to compare retrospectively the postoperative outcomes and survival rates of the transperitoneal and the retroperitoneal approach for the abdominal aortic aneurysm repair in our Unit.
  
  
  METHODS
  A retrospective analysis of 840 consecutive patients affected by AAA who were electively admitted in our unit from 1996 to 2011 was performed. Five hundred and sixty patients underwent surgical treatment, 193 through a transperitoneal approach (TP group) and 367 by a retroperitoneal approach (RP group). Short and long-term postoperative outcomes were compared in the two groups.
  
  
  RESULTS
  The RP group was characterized by significantly fewer ICU admissions and fewer respiratory and cardiac postoperative complications. Canalization and oral feeding occurred earlier and the mean length of hospital stay for the RP group was shorter compared with that for the TP group. Twelve months survival rate in the RP group was significantly higher comparing with the TP group. Similarly higher survival rates were also observed at 180 months follow-up.
  
  
  CONCLUSIONS
  In our study the repair of AAA through a retroperitoneal approach was associated with positive outcomes particularly in high-risk patients. It represents a valid therapeutic option especially in subjects not suitable for endovascular procedures. Surgical training and competence should be maintained to ensure the selection of the appropriate therapy for each patient.
authors.affiliation: Unit of Vascular and Endovascular Surgery, Surgical Department, University of Ferrara, Ferrara, Italy - niki.tsolaki@gmail.com.
authors.forename: Elpiniki
authors.initials: E
authors.lastname: Tsolaki
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Gasbarro
authors.forename: Tiberio
authors.initials: T
authors.lastname: Rocca
authors.forename: Luca
authors.initials: L
authors.lastname: Traina
authors.forename: Sabrina
authors.initials: S
authors.lastname: Sileno
authors.forename: Giorgia
authors.initials: G
authors.lastname: Gastrucci
authors.forename: Francesco
authors.initials: F
authors.lastname: Mascoli
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012187:Retroperitoneal Space / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome