The extended retroperitoneal approach for treatment of extensive atherosclerosis of the aorta and renal vessels

The aorta was exposed by a standard "nephrectomy" incision through the eleventh interspace in 53 patients with aneurysmal or occlusive disease. The plane posterior to the kidney and uretex was developed easily, enabling exposure of the aorta above the level of the celiac axis to its bifurcation by dividing only the crus of the diaphragm and the lumbar branch of the left renal vein. Twenty-five patients with abdominal aortic aneurysms were treated in this fashion. In all but four there were significant risk factors, including extension of the aneurysm to or above the level of the renal arteries in eight and coexisting renal artery stenosis with hypertension in two. Twenty-eight patients with occlusive vascular disease were treated surgically. In eight, this was the second operation on the aorta while in 11, major occlusive disease involved the aorta as well as the renal/visceral arteries. The operative mortality rate was 8%. Eighty-nine percent of the patients were alive at this writing. Of 18 hypertensive patients, 9 were not taking medication and only 3 have not improved significantly. We recommend this approach for reoperations on the aorta and for patients who have extensive aneurysmal and/or occlusive disease of the aorta, renal, and visceral arteries.