Open Aortic Reconstruction Configurations for Retroperitoneal Approach to Aortic Aneurysms: Aorto-Femoral Reconstruction is a Negative Predictor of Long-Term Outcomes

Left retroperitoneal approach for open repair of abdominal aortic aneurysms is well established safety and efficacy. The proliferation endovascular repairs has changed the landscape pattern aneurysmal disease treated with repairs. purpose this study to evaluate outcomes performed via left based on outflow configurations. A single-institution surgery management system was queried aneurysm from 1979 2022. Demographics, comorbidities, indications, operative details were recorded. Reconstruction configurations grouped into tube graft (TUBE), aortobiiliac (ABI), aortobifemoral (ABF), aorto-unifemoral-uniiliac bypass (AUI). groups compared using standard statistics. total 4425 performed, which 3318 (75%) males a mean age 71 years (range, 36-95 years). Comorbidities included hypertension 1062 (24%), diabetes 438 (9.9%), coronary 610 (13.8%), pulmonary 274 (6.2%), renal failure 115 (2.6%), tobacco use 1371 (31%). Indications asymptomatic (3407; 77%), rupture (575; 13%), symptomatic (398; 9%), pseudoaneurysm (44; 1%). Mean size 6 cm 2.2-20 cm). Configurations TUBE (1457, 32.9%), ABI (2064, 46.6%), ABF (620, 14.0%), AUI (284, 6.4%). Rupture rate by configuration 233 (16%), 165 (8%), 133 (21.6%), 47 (16.6%). Operative mortality 3.6% (8.9% ABF, 4.6% TUBE, 2.1% AUI, 1.5% ABI; P < .05). Non-fatal cardiac events 11.8% 6% 5.2% 3.9% (P Colonic ischemia 7.3% 6.3% 3.5% 2.3% = .06). Early occlusion 2.5% 1.9% 1.8% ABI, 0.5% TUBE. Wound infection rates higher in femoral (TUBE & 30 [0.85%] vs 25 [2.77%]; .0001). treatment offers excellent results; however, there may be some advantages different between groups, but it reflects degree ruptures potential pre-existing systemic atherosclerotic burden. added complexity counter incision right iliac exposure justified terms reducing wound rates.