Expert Commentary
Abstract
Expert Commentary SAGE Publications, Inc.1990DOI: 10.1177/153100359000300110 Thomas F. JrO'DonnellM.D. The title of this comprehensive review of the retroperitoneal approach b~r Drs. Cambria and Brewster would imply that the advantage of such an approach n1ay be more fancy than fact-a contention with which I cannot agree. It is evident that the retroperitoneal approach has an important role in the management of aortic problems, particularly aneurysms.1-3 What perhaps is fancy is to apply this approach universally for aortic procedures. Certainly for aortic occlusive disease (AOD) or for moderate-size (<7 cm) infrarenal aortic aneurysms, the transperitoneal approach is expeditous and adequate. In commenting on this excellent review, I would like to address three areas: (1) the original study by the authors, which provides the basis for their review; (2) the techniqud of the retroperitoneal approach; and (3) our experience and present indications for this approach. Surgeons certainly recognize that the morbidity and mortality associated with aortic reconstruction has improved in the last decade because of factors other than operative technique alone. The use of preoperative cardiac screening with noninvasive objective techniques for determining the extent of coronary artery disease, such as dipyridamole thallium scanning, has reduced cardiac- related mortality and morbidity,