Treatment
14
Table 4. Surgical Approaches for Open Aneurysm Repair
Transperitoneal Retroperitoneal
Advantages • Most rapid, greatest
versatility
• Provides widest access
• Enables evaluation and
treatment of concomitant
intra-abdominal disease
• Avoids hostile abdomen
• Facilitates suprarenal exposure
and control
• Potential reduction of
postoperative ileus
• Obesity
• Inflammatory AAA
• Horseshoe kidney
Disadvantages • Longer postoperative ileus
• Potential for greater fluid
losses
• Difficulty with exposure
and control for suprarenal
aneurysms
• Higher incidence of
incisional hernia
• Poor access to right renal and
iliac arteries
• Cannot evaluate intra-
abdominal disease
• Flank bulge
Adapted from Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, et al.
e care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice
guidelines. J Vasc Surg. 2009;50(Suppl):S2-49.
Perioperative Outcomes of Open AAA Repair
➤ The SVS suggests that elective OSR for AAA be performed at centers
with an annual volume of ≥10 open aortic operations of any type and a
documented perioperative mortality of ≤5%. (2-C)
