ABSTRACT
An important consideration is the diameter of the aorta at or just below the renal arteries in relation to the largest transverse/AP diameter of the abdominal aortic aneurysm (AAA). In general, the indication for repair in saccular aneurysm is 4.5 cm in anterior-posterior/transverse diameter. Open repair of infrarenal AAA is infrequently performed as the preferred method of treatment of infrarenal AAA is endovascular repair in patients with suitable anatomy. A left flank retroperitoneal approach is exceedingly useful in patients with complex aortic neck anatomy and significant chronic obstructive pulmonary disease. In the era of endovascular repair, most patients who required open repair have either juxtarenal or pararenal aortic aneurysms. In order to obtain optimal exposure of the pararenal aorta, the left renal vein may have to be divided and ligated, which is performed close to the inferior vena cava preserving collateral flow via adrenal and gonadal vein.
