Aortobifemoral bypass via paramedian incision and retroperitoneal approach for aortoiliac occlusive disease

Abstract

Introduction : Aorto-bifemoral graft bypass operation is performed in the surgical treatment of aortoiliac occlusive occlusive disease. The conventional standard technique used is the median laparotomy and transperitoneal approach. In this study we evaluated the outcome of aortobifemoral bypass operation via paramedian and retroperitoneal approach. Methods : 17 patients were operated upon for aortobiiliac occlusive disease from January 2008 through December 2011. Mean age of the patients was 61.8 ± 8.9 (47-78 years). All patients except for one were operated via left paramedian vertical 8 to 10 cm incision approximately 6 cm to the left or right of midline, extending from a few centimeters above the umbilicus to just above the symphysis pubis. The aortas were reached retroperitoneally through this incision. Results : There was one postoperative death secondary to pulmonary complications. No intraoperative or postoperative surgical complication had occured. All patients were discharged from the hospital on antiplatelet therapy. Graft patency was evaluated by means of physical examination on discharge. Upon the patients' hospital discharge, primary graft patency was 100%. The ankle-brachial indices measured from both the right and left sides were 0.51 ± 0.10 preoperatively and 0.99 ± 0.14 postoperatively (p < 0.001). Discussion : A lot of complications can be observed due to median laparotomy such as evisceration, incisional hernia, peritonitis, bride ileus. We believe that retroperitoneal approach for aorto-bifemoral graft bypass operation in the patients with bilateral iliac arterial occlusive disease is a well tolerated minimally invasive operation when compared to the conventional median laparotomy approach. © Acta Chirurgica Belgica 2013.