Morbidity with retroperitoneal procedures during XXXX repair.

@entity1 @entity1029 @entity1028 @entity190
PURPOSE: Retroperitoneal iliac procedures can enable successful endovascular repair of @entity1028 ( @entity1028 ) in @entity1 who otherwise would not be anatomically eligible. The purpose of this study was to determine perioperative outcome with adjunctive retroperitoneal procedures compared with standard bilateral femoral exposure. METHODS: Between August 1997 and November 2002, 164 @entity1 underwent elective @entity1028 repair at a single university medical center. Anatomic, demographic, and early postoperative outcome data gathered prospectively were analyzed. Thirty-two @entity1 (20%) underwent 38 separate adjunctive retroperitoneal procedures. Indications included small external iliac arteries (16 of 32 @entity1 ; 50%) and concomitant @entity1029 that precluded fixation of the endograft limbs in the common iliac arteries (16 of 32 @entity1 ; 50%). The 38 procedures consisted of 8 iliac conduits only, 14 iliac conduits with iliofemoral bypass grafts, and 16 hypogastric revascularization procedures. Data for the study @entity1 were compared with data for 132 @entity1 who underwent @entity1028 repair through femoral incisions. Primary end points were hospital length of stay, and early morbidity and mortality. RESULTS: Retroperitoneal procedures enabled an additional 14% of @entity1 with @entity1028 to undergo endovascular techniques. However, there was a significantly higher proportion of @entity1 and @entity1 at high risk for anesthesia (American Society of Anesthesiologists class IV or higher) in the group who underwent retroperitoneal procedures. On average, retroperitoneal procedures were associated with 2.6-fold greater @entity190 , 82% longer procedure time, 1.5 days additional hospital stay, and 1.8-fold higher rate of perioperative complications, compared with @entity1028 repair with femoral exposure alone. In contrast, early mortality was similar in the two groups. CONCLUSION: Adjunctive retroperitoneal procedures during @entity1028 repair are associated with increased risk for complications and longer hospital length of stay, compared with @entity1028 repair with standard femoral exposure only. They do not, however, increase early mortality, even in @entity1 at high risk, and enable a larger subset of @entity1 with @entity1028 to undergo endovascular repair.
