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Aortoiliac Reconstruction: The Retroperitoneal Approach and Splenic Injury

  • Papers Presented at the Thirteenth Annual Winter Meeting of the Peripheral Vascular Surgery Society
  • Published:
Annals of Vascular Surgery

Abstract

Exposure of the abdominal aorta through the left retroperitoneum is a well-accepted technique. Unfortunately, splenic injury is a complication of this approach that rarely occurs through a mid-line transabdominal incision. In this series we evaluate the occurrence of splenic injury during left retroperitoneal aortic surgery. The records of all patients undergoing abdominal aortic reconstruction via the left retroperitoneal approach were reviewed from 1988 to 2001. Indications included either abdominal aortic aneurysm (AAA) or aortoiliac occlusive disease (AIOD). Thoracoabdominal aneurysms and visceral aortic reconstructions were excluded. Those patients that required splenectomy for splenic injury were stratified and analyzed for demographics, indications for operation, and other complications. Chi-square analysis was used to determine statistical significance. Over the 13-year study period, 2889 aortic reconstructions were performed. These consisted of 1773 elective AAA repairs, 357 ruptured or symptomatic AAA repairs, and 759 aortofemoral bypasses for AIOD. Splenectomies were performed after aortic repair in 21 (0.7%) patients. Breakdown by indication totaled 11/1773 (0.6%) for elective AAA repair, 7/357 (2.0%) for rupture or symptomatic AAA repair, and 3/759 (0.4%) for AIOD (p < 0.05). Mortality for patients undergoing elective AAA without splenectomy was 1.9% (34/1762) and with splenectomy was 9.1% (1/11), while it was 3.2% (24/756) for AIOD patients without splenectomy and 14% (1/7) for AIOD patients with splenectomy (all p = NS). Splenic injury can occur in elective and emergent aortic reconstructions performed through the left retroperitoneum. The surgeon should be prepared for splenectomy whenever intraperitoneal blood or hemodynamic instability is identified. Evaluation of the spleen prior to flank closure may be prudent.

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Authors and Affiliations

  1. Institute for Vascular Health and Disease, Albany Medical College, Albany, NY, USA

    Garrett Wirth MD, Roger Moccia MD, R. Clement Darling III MD, Sean P. Roddy MD, Manish Mehta MD, MPH, Bryan C. Kramer MD, Benjamin B. Chang MD, Paul B. Kreienberg MD, Philip S. K. Paty MD, Kathleen J. Ozsvath MD & Dhiraj M. Shah MD

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  1. Garrett Wirth MD
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  2. Roger Moccia MD
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  3. R. Clement Darling III MD
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  4. Sean P. Roddy MD
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  5. Manish Mehta MD, MPH
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  6. Bryan C. Kramer MD
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  7. Benjamin B. Chang MD
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  8. Paul B. Kreienberg MD
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  9. Philip S. K. Paty MD
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  10. Kathleen J. Ozsvath MD
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  11. Dhiraj M. Shah MD
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Corresponding author

Correspondence to R. Clement Darling III MD.

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Wirth, G., Moccia, R., Clement Darling, R. et al. Aortoiliac Reconstruction: The Retroperitoneal Approach and Splenic Injury . Ann Vasc Surg 17, 604–607 (2003). https://doi.org/10.1007/s10016-003-0079-x

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  • DOI: https://doi.org/10.1007/s10016-003-0079-x

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