Aortic endoprosthesis explantation: left retroperitoneal approach

The case of a patient submitted to late, elective, surgical conversion 28 months after endoluminal repair for aortic aneurysm exclusion, is presented. On follow-up, the patient had undergone percutaneous embolization due to 2 type II endoleaks and 2 proximal extender cuffs had been positioned to solve 2 type IV endoleaks. In addition, caudal migration of the stent-graft had been detected, not associated with a type I endoleak. Despite secondary procedures, the aneurysmal sac suffered progressive growth. The inevitable surgical conversion was performed through a left retroperitoneal lumbar access, to simplify the technical difficulties associated with periadventitial sclerosis. Using this approach, easy suprarenal clamping was achieved. Postoperative global function resumption of the patient was rapid, despite the patient's respiratory dysfunction, which had determined the choice of endoluminal repair.