Comparison of transperitoneal and retroperitoneal approach for aortoiliac artery occlusive disease

Abstract

This study aims to compare retroperitoneal and transperitoneal approaches in the surgical management of aortoiliac artery occlusive disease and evaluate the advantages and disadvantages of both techniques.Patients and methods: Between January 2005 and May 2013, a total of 125 patients (116 males, 9 females; mean age 60.9 years; range, 24 to 79 years) with aortoiliac artery occlusive disease were retrospectively analyzed. The patients were classified according to the paramedian incision in the retroperitoneal (n=84) and midline incision in the transperitoneal (n=41) surgical techniques. All patients were examined pre-and postoperatively for the ankle-brachial index (ABI), laboratory blood tests, type of anesthesia, length of hospital and intensive care unit (ICU) stay, amount of blood transfusion oral intake starting time, revision, extra-revascularization need, comorbidities, and mortality. Results:In the retroperitoneal technique, oral intake starting time (p<0.001), length of ICU (p<0.001) and hospital stay (p<0.001) were shorter, and the amount of blood transfusion (p<0.007) was lower, compared to the transperitoneal technique. The patients who underwent one-side revascularization in the retroperitoneal group had epidural anesthesia (n=10). There was no significant difference in the mortality, revision, and the need for extra revascularization rates between the groups. Conclusion:Paramedian incision and retroperitoneal surgical technique in aortoiliac occlusive management is effective and safe and can be done for unilateral extremities under epidural anesthesia.