Present techniques applicable to retroperitoneal surgery for complex aortic reconstructions in an era when open surgical repair is reserved for patients who are not candidates for an endovascular approach.

The key elements of five distinct cases including AAA with accessory renal artery, right iliac aneurysm, or aotoiliac occlusive disease requiring aorto-bifemoral bypass, suprarenal aneurysm and a type IV thoracoabdominal aneurysm with aortic dissection are presented using high quality video.

Patients with aortic disease who are not candidates for endovascular alternatives usually require more complex and extensive open surgical repair. Vascular surgeons must be familiar with surgical techniques applicable in these cases. This video presents key aspects of the retroperitoneal approach to aortic pathology from the supra-celiac aorta to the femoral arteries. Specific elements from five distinct cases illustrate the surgical approach. These include incision placement, ante or retro renal dissection, right common iliac bifurcation exposure, aorto- bifemoral tunneling, bypass versus reimplantation of renal and/or visceral vessels, and trans diaphragmatic distal descending thoracic aortic control.

Vascular surgeons must be familiar with surgical techniques applicable in patients with aortic pathology who are not candidates for endovascular alternatives. These cases frequently require more complex and extensive open surgical repair.A retroperitoneal approach can be used and may be preferred in these complicated cases.