A Comparison of the Retroperitoneal to the Transabdominal Approach for AAA Repair in Octogenarians who are not Endoluminal Candidates

Objectives: This study compares the outcomes from a retroperitoneal to a transabdominal abdominal aortic aneurysm repair in octogenarians who were not endoluninal candidates.
Methods: Thirty-five octogenarians with a mean age of 83 years, underwent AAA repair. Repairs were performed through a midline transabdominal (TA) incision in 18, or through a left retroperitoneal (RP) incision in 17 patients. Aortic tube grafts were utilized in respectively, eight and five, RP and TA patients while an aorto bi-iliac bypass graft was used in the remainder of the patients. Both the RP and TA groups had similar preoperative risk factors and indications.
Results: Surgical time and blood loss was similar for the RP and TA groups. At least one major complication occurred in three RP and 14 TA patients (x² p<0.005). There were no MIs in the RP group while there were four in the TA group. Pneumonia occurred in one RP and four TA patients. Acute renal failure occurred in two RP and six TA patients. This required hemodialysis in four TA patients. One RP patient (6%) died within 30 days of surgery while four TA patients (22%) had a similar demise. The postoperative length of stay was 7.4 + 3.2 and 13.9 + 11.8 days for respectively, the RP and TA group (t-test p<0.05).
Conclusions: It appears that octogenarians with a AAA who are not endoluminal candidates may do better with a retroperitoneal approach with lower mortality, fewer postoperative complications and a shorter postoperative length of stay than with a transabdominal approach.