Sometimes, comorbid conditions can complicate the repair of AAA. These include hepatobiliary, gastrointestinal, pancreatic, gynaecological and genitourinary problems. Therefore, careful preoperative evaluation should be done and more life threatening condition should be treated first.
A number of anatomical variants can also occur in many patients. These include venous anomalies, accessory renal arteries and horseshoe kidneys.
Usually, there are 3-5 renal arteries in patients with horseshoe kidneys and in order to maintain kidney function, it is necessary to reimplant renal arteries arising from the aneurysm. The presence of horseshoe kidney also creates difficulties in transperitoneal approach. Thus, in such cases, left retroperitoneal approach is used.
The common venous anomalies seen are circumaortic venous rings, retroaortic left renal vein, azygous continuation of inferior vena cava and bilateral inferior vena cava. All these anomalies lead to unnecessary bleeding and require careful dissection.
Inflammatory AAA leads to extensive involvement of surrounding structures and makes the repair difficult. Thus, retroperitoneal approach is used to overcome the intraoperative difficulties.
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