Extraperitoneal aortofemoral bypass
An extraperitoneal exposure of the infra-renal aorta is described. This exposure differs slightly from that described by Rob and others in that the inferior epigastric artery is not sacrificed during the exposure. 47 operations for aorta-femoral bypass procedures have been done through this exposure with one post-operative death. The virtual absence of post-operative ileus, the very low incidence of lung complications and the overall smooth post-operative course are the main advantages of this exposure over the more conventional transperitoneal route. The only real disadvantage is that the exposure of the aorta is rather more difficult than in the transperitoneal approach, but this can be greatly reduced by sacrifice of the lower lumbar arteries and the inferior mesenteric artery. The potential danger of twisting of the right leg of the prosthesis was not encountered.