Exclusion bypass of a difficult abdominal aortic aneurysm.

Aortic repair by graft replacement is currently the most generally accepted and widely used technique in the treatment of infrarenal abdominal aortic aneurysm. Many alternative approaches have been considered in order to limit the physiological stress of surgery. A recently described technique involves an extraperitoneal approach to the abdominal aorta, whereby the aneurysm is left in situ, excluded from arterial pressure, and an infrarenal aortic bypass is performed. In this case report, this exclusion bypass technique was safely applied through a transperitoneal approach to manage a very large, tortuous and displaced infrarenal abdominal aortic aneurysm which was densely adherent to the left kidney and ureter.