Paramedian retroperitoneal approach for revascularization of aortoiliac occlusive disease

Background: This study aims to examine unilateral and bilateral revascularization of aortoiliac occlusive disease via paramedian incision and retroperitoneal approach. Methods: Between January 2005 and December 2012, 74 patients (67 males, 7 females; mean age 61.6 +/- 9.5 years; range 24 to 79 years) underwent surgical revascularization for aortoiliac occlusive disease via paramedian incision and retroperitoneal approach [aortofemoral bypass (n=40), iliofemoral bypass (n=14), aortoiliac bypass (n=2) and aortobifemoral bypass (18)]. Data of the patients for unilateral aortoiliac revascularization were compared with those for bilateral aortoiliac revascularization. The preoperative characteristics and perioperative data of the patients were analyzed. Results: Three patients (3.9%) died postoperatively due to myocardial infarction and pulmonary complications. No intraoperative complications occurred. Six patients required subsequent reoperation: two for acute distal embolism to the contralateral limb, two for distal anastomosis leakage, and two for local distal wound infection. These patients were successfully treated. The patients were discharged from the hospital on antiplatelet therapy. There was no significant difference in the length of intensive care unit stay, time to oral intake, preoperative and postoperative hemoglobin levels, hematocrit levels, creatinin levels, and need for transfusion between the unilateral and bilateral revascularization patients. Conclusion: Based on our experience, the retroperitoneal aortoiliac approach with a paramedian incision has few complications and reasonable outcomes.