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Comparison of Retroperitoneal and Transperitoneal Approach for Open Abdominal Aortic Aneurysm Repair in the Endovascular Era
Jeffrey J. Siracuse, M.D., Georges Tahhan, M.S., Alik Farber, M.D., Jeffrey A. Kalish, M.D., Denis Rybin, M.S., Gheorghe Doros, Ph.D., Mohammad H. Eslami, M.D..
Boston University, Boston, MA, USA.
Objectives: Open repair of abdominal aortic aneurysms (AAA), using the retroperitoneal (RP) and transperitoneal (TP) approach, is still required in the era of endovascular repair for selective patients. Our goal was to assess differences in outcomes based on the type of elective open AAA repair in a contemporary patient sample.
Methods: The National Surgical Quality Improvement Program (NSQIP) targeted open aorta database was queried for all elective cases of open AAA repair. Patient demographics, comorbidities, aneurysm and operative details were recorded. RP and TP approaches were compared to understand their effect on perioperative morbidity and mortality. Multivariable analyses, adjusting for comorbidities, aneurysm extent, and clamp location were performed to isolate the effect of approach on outcomes.
Results: We identified 949 open AAA repairs - 283 RP and 666 TP. Although the average age and comorbidities were similar between groups there was a higher frequency of males in the RP cohort (76.6% vs. 65%, p<0.001). The RP group had a significantly higher frequency of patients with prior abdominal surgery (36.6% vs. 23.8%, P<.001). RP patients were less likely to have an infrarenal clamp (32.2% vs. 61.5%, P<.001) or iliac involvement (41.1% vs. 56.6%, P<.001), and more likely to have renal (23.3% vs. 7.1%) and visceral (8.5% vs. 2.6%) revascularization (P<.001). Multivariate analysis showed no difference in RP vs. TP for 30 day mortality (OR 0.69, 95% CI 0.252-1.885, P=.469), cardiac (OR 1.01, 95% CI 0.41-2.53, P=.98), pulmonary (OR 1.05, 95% CI 0.656-1.685, P=.835), or wound complications (OR 0.45, 95% CI 0.171-1.194, P=.109), ischemic colitis (OR 0.99, 95% CI 0.305-2.089, P=.646), acute renal failure (OR 2.143, 95% CI 0.954-4.81, P=.065), 30 day readmission (OR 1.69, 95% CI 0.874-3.269, P=.119), or postoperative length of stay (OR 0.95, 95% CI 0.857-1.058, P=.365).
Conclusions: We found no difference in perioperative morbidity and mortality for RP compared to TP approach for open AAA repair. The type of approach for open AAA repair should be individualized based on aneurysm characteristics and surgeon preference.
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