학술논문
Retroperitoneal Compared to Transperitoneal Approach for Open Abdominal Aortic Aneurysm Repair Is Associated with Reduced Systemic Inflammation and Postoperative Morbidity.
Document Type
Academic Journal
Author
Bailey DM; Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom.; Rose GA; Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom.; O'Donovan D; Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom.; Locker D; Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom.; Appadurai IR; Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom.; Davies RG; Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom.; Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom.; Whiston RJ; Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom.; Bashir M; Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom.; Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom.; Lewis MH; Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom.; Williams IM; Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom.; Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom.
Source
Publisher: Thieme Country of Publication: Germany NLM ID: 101655549 Publication Model: Print-Electronic Cited Medium: Print ISSN: 2325-4637 (Print) Linking ISSN: 23254637 NLM ISO Abbreviation: Aorta (Stamford) Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2325-4637
Abstract
Background: In the United Kingdom, the most common surgical approach for repair of open abdominal aortic aneurysms (AAAs) is transperitoneal (TP). However, retroperitoneal (RP) approach is favored in those with more complex vascular anatomy often requiring a cross-clamp on the aorta superior to the renal arteries. This study compared these approaches in patients matched on all major demographic, comorbid, anatomic, and physiological variables.
Methods: Fifty-seven patients (TP: n = 24; RP: n = 33) unsuitable for endovascular aneurysm repair underwent preoperative cardiopulmonary exercise testing prior to open AAA repair. The surgical approach undertaken was dictated by individual surgeon preference. Postoperative mortality, complications, and length of hospital stay (LoS) were recorded. Patients were further stratified according to infrarenal (IR) or suprarenal/supraceliac (SR/SC) surgical clamping. Systemic inflammation (C-reactive protein) and renal function (serum creatinine and estimated glomerular filtration rate) were recorded.
Results: Twenty-three (96%) of TP patients only required an IR clamp compared with 12 (36%) in the RP group. Postoperative systemic inflammation was lower in RP patients ( p = 0.002 vs. TP) and fewer reported pulmonary/gastrointestinal complications whereas renal impairment was more marked in those receiving SR/SC clamps ( p < 0.001 vs. IR clamp). RP patients were defined by lower LoS ( p = 0.001), while mid-/long-term mortality was low/comparable with TP, resulting in considerable cost savings.
Conclusion: Despite the demands of more complicated vascular anatomy, the clinical and economic benefits highlighted by these findings justify the more routine adoption of the RP approach for complex AAA repair.
Competing Interests: The authors declare no conflict of interest related to this article.
(The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)
Methods: Fifty-seven patients (TP: n = 24; RP: n = 33) unsuitable for endovascular aneurysm repair underwent preoperative cardiopulmonary exercise testing prior to open AAA repair. The surgical approach undertaken was dictated by individual surgeon preference. Postoperative mortality, complications, and length of hospital stay (LoS) were recorded. Patients were further stratified according to infrarenal (IR) or suprarenal/supraceliac (SR/SC) surgical clamping. Systemic inflammation (C-reactive protein) and renal function (serum creatinine and estimated glomerular filtration rate) were recorded.
Results: Twenty-three (96%) of TP patients only required an IR clamp compared with 12 (36%) in the RP group. Postoperative systemic inflammation was lower in RP patients ( p = 0.002 vs. TP) and fewer reported pulmonary/gastrointestinal complications whereas renal impairment was more marked in those receiving SR/SC clamps ( p < 0.001 vs. IR clamp). RP patients were defined by lower LoS ( p = 0.001), while mid-/long-term mortality was low/comparable with TP, resulting in considerable cost savings.
Conclusion: Despite the demands of more complicated vascular anatomy, the clinical and economic benefits highlighted by these findings justify the more routine adoption of the RP approach for complex AAA repair.
Competing Interests: The authors declare no conflict of interest related to this article.
(The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)