A retroperitoneal operative approach is associated with improved perioperative outcomes compared with a transperitoneal approach in open repair of complex abdominal aortic aneurysms

Vinamr Rastogi, Christina L. Marcaccio, Priya B. Patel, Rens R.B. Varkevisser, Virendra I. Patel, Peter A. Soden, Jorg L. de Bruin, Hence J.M. Verhagen, Marc L. Schermerhorn*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

Objective: Several studies have demonstrated the advantages of a retroperitoneal (RP) vs a transperitoneal (TP) approach during open repair of infrarenal abdominal aortic aneurysms (AAAs). We compared the outcomes after open repair of complex AAAs (cAAAs) using an RP vs a TP approach and evaluated the relative use of these approaches over time. Methods: We identified all patients who had undergone open intact cAAA repair in the Vascular Quality Initiative from 2003 to -2019 and created 1:1-propensity score-matched cohorts stratified by the operative approach (RP vs TP). The primary outcome was perioperative mortality. The secondary outcomes included perioperative complications and approach usage over time. To create 1:1 propensity score-matched cohorts, the patients were matched for demographics, comorbidities, and anatomic and/or intraoperative characteristics, including proximal clamp site and renal revascularization. The approach usage over time was determined by plotting the proportion of RP usage over time for the overall open cAAA cohort and subgroups of repairs using a supraceliac cross clamp, repair with concomitant renal revascularization, and repairs performed at high-volume centers (highest quintile, >11 cases annually). Results: Of a total of 4613 patients, 2843 (62%) had undergone open cAAA repair using the TP approach and 1770 (38%) using the RP approach. Of the 1256 matched pairs, the RP approach was associated with lower risk of perioperative mortality compared with the TP approach (3.9% vs 6.8%; relative risk [RR], 0.57; 95% confidence interval [CI], 0.41-0.80; P = .001). Furthermore, the RP approach was associated with a lower risk of cardiac complications (7.2% vs 9.6%; RR, 0.75; 95% CI, 0.58-0.98), bowel ischemia (3.1% vs 5.4%; RR, 0.56; 95% CI, 0.39-0.84), and postoperative dialysis (3.3% vs 5.5%; RR, 0.59; 95% CI, 0.41-0.87). Overall, the proportion of patients who had undergone repair via an RP approach became lower over time (−1.0%/y; 95% CI, −1.5 to −0.5; P < .001). A similar trend in the decrease was found for the patients who had undergone repair with a supraceliac clamp (−2.3%/y; 95% CI, −3.6 to −1.0; P < .001) and in the high-volume hospitals (−2.1%/y; 95% CI, −3.4 to −0.8; P = .001), although no statistically significant decrease in RP usage was found for the patients who had undergone concomitant renal revascularization (−0.9%/y; 95% CI, −2.6 to 0.8; P = .28). Conclusions: For open cAAA repair, an RP approach was associated with lower perioperative mortality and complications compared with a TP approach. However, the relative usage of the RP approach has been decreasing over time. An increased adoption of the RP approach, when appropriate, might lead to improved outcomes with open cAAA repair.

Original languageEnglish
Pages (from-to)354-363.e1
JournalJournal of Vascular Surgery
Volume76
Issue number2
DOIs
Publication statusPublished - 1 Aug 2022

Bibliographical note

The present study was conducted with support from Harvard Catalyst , Harvard Clinical and Translational Science Center ( National Center for Research Resources and National Center for Advancing Translational Sciences, National Institutes of Health grant UL1 TR002541 ) and financial contributions from Harvard University and its affiliated academic health care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University, or its affiliated academic health care centers or the National Institutes of Health. C.L.M. is supported by the Agency for Healthcare Research and Quality (grant F32HS027285 ). The content is solely responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. P.B.P. is supported by the Harvard-Longwood Research Training in Vascular Surgery National Institutes of Health T32 grant (grant 5T32HL007734 ).

Publisher Copyright: © 2022

Fingerprint

Dive into the research topics of 'A retroperitoneal operative approach is associated with improved perioperative outcomes compared with a transperitoneal approach in open repair of complex abdominal aortic aneurysms'. Together they form a unique fingerprint.

Cite this