Mohammad Alşalaldeh, Bilgin Emrecan
Department of Cardiovascular Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
Keywords: Aortoiliac occlusive disease, median incision, paramedian incision, retroperitoneal technique, transperitoneal technique
Objectives: This study aims to compare retroperitoneal and transperitoneal approaches in the surgical management of aortoiliac artery occlusive disease and evaluate the advantages and disadvantages of both techniques.
Patients and methods: Between January 2005 and May 2013, a total of 125 patients (116 males, 9 females; mean age 60.9 years; range, 24 to 79 years) with aortoiliac artery occlusive disease were retrospectively analyzed. The patients were classified according to the paramedian incision in the retroperitoneal (n=84) and midline incision in the transperitoneal (n=41) surgical techniques. All patients were examined pre- and postoperatively for the ankle-brachial index (ABI), laboratory blood tests, type of anesthesia, length of hospital and intensive care unit (ICU) stay, amount of blood transfusion oral intake starting time, revision, extra-revascularization need, comorbidities, and mortality.
Results: In the retroperitoneal technique, oral intake starting time (p<0.001), length of ICU (p<0.001) and hospital stay (p<0.001) were shorter, and the amount of blood transfusion (p<0.007) was lower, compared to the transperitoneal technique. The patients who underwent one-side revascularization in the retroperitoneal group had epidural anesthesia (n=10). There was no significant difference in the mortality, revision, and the need for extra revascularization rates between the groups.
Conclusion: Paramedian incision and retroperitoneal surgical technique in aortoiliac occlusive management is effective and safe and can
be done for unilateral extremities under epidural anesthesia.