Extraperitoneal aortic bypass with exclusion of the intact infra-renal aortic aneurysm: the in-situ management of aortic aneurysms. A preliminary report.

Transabdominal aortic aneurysmorraphy with graft replacement is the generally accepted and most widely applied surgical approach in the treatment of infra-renal abdominal aortic aneurysm with a mortality rate of 2-5%. The alternative, retroperitoneal exposure of the aorta, although utilized for the first reported repair of an AAA by Dubost and championed by Rob, Stipa and Shaw, Helsby and Moosa and more recently by Williams et al., offers superior exposure and decreased post-operative morbidity. Despite these advantages, it is not commonly used by most vascular surgeons for the surgical management of aortic aneurysms. We have treated 35 patients using an extended retroperitoneal approach in which the aneurysm was treated by division of the infra-renal aorta, an end-to-end proximal anastomosis with an aortic bypass, and over-sewing of the aneurysm. In this group of patients, we found less post-operative physiological disturbances and a reduced requirement for blood transfusion. These data suggest that this method of retroperitoneal exclusion and bypass is generally applicable and is of particular value in the obese and/or the higher risk, medically disadvantaged patient.