Very Long-Term Outcomes Of Abdominal Aortic Repair Using A Mini-Laparotomy Approach

Open abdominal aortic aneurysm repair (oAAA) is still a valid technique even nowadays in the endovascular era. This study analyzed early and very long-term outcomes of oAAA using a mini-laparotomy access (m-Lap). A total of 650 consecutive patients (mean age, 73 ± 6.9 years; 598 males) undergoing elective oAAA using an m-Lap between 2004 and 2014, were included. A transperitoneal approach was performed through a 12- to 15-cm longitudinal incision along the linea alba (from xiphoid process to 1 cm below the belly button). Exposure of the retroperitoneum was obtained using a static mechanical retractor (Omni-tract, St Paul, Minn). Contraindications to m-Lap were a body mass index >30, previous aortic or abdominal surgery, and life-expectancy <5 years. Surgical and clinical outcomes are provided. Median length of stay, procedure time, and blood loss was 4 days (interquartile range [IQR], 3-5 days), 182 minutes (IQR, 165-225 minutes), and 200 mL (IQR, 400-700 mL). Infrarenal clamping and tube graft configuration was used in 97.7% (n = 635) and 71.2% (n = 463) of the patients, respectively. The 30-day mortality and complication rate were 0.7% (n = 5) and 12.7% (n = 83), respectively. Thirty-day outcomes are reported in the Table. The median follow-up was 100 months (IQR, 60-143 months). Overall survival was 97.8% at 1 year, 83.3% at 5 years, 60% at 10 years, and 34.3 at 15 years. Ten aneurysm-related deaths (1.5%) occurred during the entire follow-up (Fig). Freedom from reintervention was 98.7% at 1 year, 96.9% at 5 years, 95% at 10 years, and 84.8% at 15 years. Eighty incisional hernias (12.3%) occurred, but only 25 (31%) were repaired during follow-up. Six (0.9%) graft infections and three (0.5%) limb occlusions occurred at 15 years. Predictors for mortality were age >80 years (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8-4.4; P < .001), statin therapy (OR, 0.6; 95% CI, 0.4-0.9; P = .03), renal insufficiency (OR, 1.9; 95% CI, 1.2-3.1; P = .004), and intraoperative blood loss >1000 mL (OR, 1.2; 95% CI, 1.1-1.6; P = .03). The m-Lap technique for oAAA is a safe and a valid approach to treat patients with a good life expectancy, body mass index <30, and absence of hostile abdomen; it is now our first-line approach for these selected patients. Moreover, the reintervention rate is low even in a very long-term follow-up.TableThirty-day results30-day resultsNo. (%)Overall complications83 (12.7)Death5 (0.7)Myocardial infarction10 (1.5)Arrhythmia12 (1.8)Acute leg ischemia2 (0.3%)Graft infection3 (0.4%)Bleeding18 (2.7%)Renal impairment6 (1%)Pneumonia9 (1.4%)Reintervention25 (3.8) Open table in a new tab