ACTA FAC. MED. NAISS. 2005; 22 (3): 115-119

   Review article

A. Nevelsteen, I. Fourneau, K. Daenens
Dept. of Vascular Surgery, Univ. Hosp. Gasthuisberg, Leuven, Belgium

Within the community of the vascular surgeons, it has always been amatter of debate which surgical approach is tolerated better by the patient undergoing a reconstruction of the abdominal aorta. Transperitoneal approach offers several advantages: l. simple and very fast approach (very important in emergency cases), 2. allows evaluation of the whole intraabdominal cavity, 3. it is easy to expose common iliac arteries, iliac bifurcation and both external iliac arteries, 4. reconstruction of both renal arteries, as well as visceral arteries, can be performed from the infrarenal aorta, 5. inferior mesenteric artery and eventually polar renal arteries can be incorporated in infrarenal aortic graft. Anterolateral retroperitoneal approach, and various modifications (e.g. extended retroperitoneal) have been described as a well-accepted alternative to the transperitoneal approach. In most centers, the retroperitoneal approach is used actually in well-defined indication both depending on the patient and the anatomy of the aortic aneurysm. Disadvantages are also listed: l. quite time consuming compared with transperitoneal approach which makes it less attractive in emergency situations, 2. redo-operations might present a problem, 3. reimplantation of the inferior mesenteriac artery is made more difficult, 4. access to the right common iliac artery and iliac bifurcation, as well as right renal artery is cumbersome, 5. retroperitoneal approach is contraindicated in the presence of venosus anomalies. The general conclusion might be that none of the different approaches has a uniform advantage or disadvantage and that surgeons and their patients will be served best by both approaches, the choice of which is primarily dependent on the anatomical and technical requirements in each individual.

Key words: retroperitoneal approach, transperitoneal approach, abdominal aorta surgery