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Retroperitoneal approach to the abdominal aorta: Tips and tricks

In the era of endovascular repair of abdominal aneurysms (AAA) the use of traditional open surgical repair of AAA is declining. The preferred option for patients with AAAs who are young or have challenging anatomy that is not suitable for Endovascular repair is open surgical repair. Most Vascular Surgical units are familiar with the transperitoneal (TP) approach to AAA. Another useful approach to AAA is retroperitoneal (RP). Our unit has found RP a more suitable approach for repairing the AAAs with challenging anatomy and in patients with poor physiological function. RP approach provides excellent access to the juxta/supra renal aorta. In addition, patients undergoing RP have less post-operative morbidity and shorter hospital stay compared to those undergoing TP repair. Our unit recommends RP approach as the preferred option to repair AAAs unsuitable for endovascular repair. Given the relative lack of familiarity with this technique as it is not widely practised, we have described the technique/our experience and its advantages over conventional open surgery.