Optimal exposure of the proximal abdominal aorta: A critical appraisal of transabdominal medial visceral rotation

Reilly, Linda M.; Ramos, Tammy K.; Murray, Stephen P.; Cheng, Stephen W.K.; Stoney, Ronald J.

doi:10.1016/s0741-5214(94)70065-6

Cited by 65 publications

(18 citation statements)

References 19 publications

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“…21 However, the survey revealed that only 1 (3.7%) of the 27 British surgeons responding would consider this bypass procedure for the complication we describe here. The development of endovascular techniques for renal artery revascularization has dramatically reduced a surgeon's ability to experience all the options of open renal reconstruction.…”

Section: Discussionmentioning

confidence: 79%

Delayed Hepato-Spleno-Renal Bypass for Renal Salvage Following Malposition of an Infrarenal Aortic Stent-Graft

Hamish¹,

Geroulakos²,

Hughes³

et al. 2010

Journal of Endovascular Therapy

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Bilateral renal artery occlusion caused by malposition of a stent-graft is probably underreported. If revascularization of the kidneys by endovascular techniques fails, there is no consensus as to the optimal approach. Delayed revascularization should be considered if the kidneys show concentration of imaging contrast. Hepato-spleno-renal bypass, which has not heretofore been indicated for renal salvage post EVAR, can provide a good functional result in this situation.

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Section: Discussionmentioning

confidence: 79%

Delayed Hepato-Spleno-Renal Bypass for Renal Salvage Following Malposition of an Infrarenal Aortic Stent-Graft

Hamish¹,

Geroulakos²,

Hughes³

et al. 2010

Journal of Endovascular Therapy

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“…8 Most patients who underwent elective AAA repair followed by severe AP had suprarenal or celiac crossclamping, 1,2,4 which eventually led to extensive retroperitoneal dissection. 4 The mortality associated with minor AP in vascular patients is 10%, 1,3 but complications resulted in a worse prognosis in almost 100% of patients because of sepsis and multiorgan failure secondary to the pancreatic abscess. [1][2][3][4][5][6] Our patient suffered a sudden intraoperative cardiac arrest and the prolonged hypoperfusion was probably the main cause of his pancreatic ischemia, with subsequent aseptic necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…4 The mortality associated with minor AP in vascular patients is 10%, 1,3 but complications resulted in a worse prognosis in almost 100% of patients because of sepsis and multiorgan failure secondary to the pancreatic abscess. [1][2][3][4][5][6] Our patient suffered a sudden intraoperative cardiac arrest and the prolonged hypoperfusion was probably the main cause of his pancreatic ischemia, with subsequent aseptic necrosis. The extraperitoneal retrorenal access to the aorta could have been an adjunctive risk because medial displacement of the pancreatic body and tail increases the hazards of direct mechanical trauma, although we have never before encountered this complication when using this approach.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] The clinical symptoms can be vague and nonspecifi c, and the diagnosis is often delayed, if not made at autopsy. Although most cases of postoperative AP are mild or even subclinical, extensive pancreatic necrosis, possibly infected, poses a formidable challenge to the surgeon, who is faced with the dilemma of the pancreatic abscess requiring drainage and the high risk of concomitant or subsequent prosthetic infection.…”

Section: Introductionmentioning

confidence: 99%

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Infected pancreatic necrosis after extraperitoneal abdominal aortic aneurysm repair: Report of a case

2008

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“…In addition, this approach is limited by the lack of proximal exposure of the aorta, especially with disease that extended to and above the renal arteries. However, more proximal aortic exposure can be obtained by using an extended posterolateral approach as outlined by Williams et al2 This latter approach is comparable to a thoracoabdominal incision without entering the chest and parallels medial visceral rotation as pioneered by Stoney for visceral and renal aortic recon- 24,25 struction.…”

Section: Discussionmentioning

confidence: 99%

Current Status of the Use of Retroperitoneal Approach for Reconstructions of the Aorta and Its Branches

et al. 1996

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ObjectiveThe objective of this article is to determine whether retroperitoneal approach for aortic surgery has certain physiologic, technical advantages. Summary Background DataThe retroperitoneal approach for abdominal aortic reconstruction classically had been reserved for select patients with either high-risk comorbid disease or specific anatomic problems that preclude the transabdominal approach. With increasing appreciation of the physiologic, anatomic, and technical advantages of the extended posterolateral retroperitoneal approach, the authors have expanded its use for repair of all types of aortic visceral and renal artery disease as well as ruptured abdominal aortic aneurysm and infected aortic grafts. MethodsFrom January 1981 to September 1995, 2340 retroperitoneal aortoiliac reconstructions were performed in 2243 patients. Aortic reconstructions accounted for 1756 cases: 1 109 for elective abdominal aortic aneurysms, 210 for ruptured and symptomatic aortic aneurysms, 399 for occlusive disease, 18 for infected aortic grafts, and 20 for other indications. Iliofemoral disease was the indication for 584 procedures. As experience was gained, this approach also was used for 417 renal and 50 celiac and superior mesenteric artery reconstructions. ResultsThe mean age was 67 years with 1590 men and 653 women. Overall mortality was 5.2% for all aortic cases: 2.4% for elective, 12.6% for symptomatic, and 29.0% for ruptured aortic aneurysms. Major complications occurred in 12.5% of the elective procedures and in 38.3% of emergency procedures. Over the past 5 years, the average length of hospital stay for uncomplicated elective abdominal aortic aneurysms was 6.1 days, intensive care unit stay was 0.7 day, and diet was resumed by postoperative day 1. Five-year graft patency was 99% for aneurysms and 95% for occlusive disease. ConclusionsThe retroperitoneal approach offers certain physiologic advantages associated with minimal disturbance of gastrointestinal and respiratory function, thereby reducing the length of intensive care unit and hospital stay. In addition, its technical advantages and flexibility facilitates visceral and juxtarenal aortic reconstructions without the need for thoracotomy. 501

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Optimal exposure of the proximal abdominal aorta: A critical appraisal of transabdominal medial visceral rotation

Cited by 65 publications

References 19 publications

Delayed Hepato-Spleno-Renal Bypass for Renal Salvage Following Malposition of an Infrarenal Aortic Stent-Graft

Delayed Hepato-Spleno-Renal Bypass for Renal Salvage Following Malposition of an Infrarenal Aortic Stent-Graft

Infected pancreatic necrosis after extraperitoneal abdominal aortic aneurysm repair: Report of a case

Current Status of the Use of Retroperitoneal Approach for Reconstructions of the Aorta and Its Branches

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