Emil Hadzhiev¹*, Ahmed Hodzhov¹ and Valentin Govedarski²

¹Clinic of Vascular and Endovascular Surgery, University Multiprofile Hospital for Active Treatment “St. Ekaterina”, Sofia, Bulgaria ²Professor, Clinic of Vascular and Endovascular Surgery, University Multiprofile Hospital for Active Treatment “St. Ekaterina”, Sofia, Bulgaria

*Corresponding Author: Emil Hadzhiev, Clinic of Vascular and Endovascular Sur- gery, University Multiprofile Hospital for Active Treatment “St. Ekaterina” – EAD, 62 Pencho Slaveykov Blvd, Sofia, Bulgaria.

Received: September 17, 2026; Published: October 16, 2026

Background: Occlusive disease of the aortoiliac segment is a relatively common condition, and several surgical approaches to the aortoiliac segment have been described. This study reports our clinical experience with extra-anatomic aorto-bifemoral bypass performed through a retroperitoneal approach, including the postoperative outcomes of our patient cohort and a representative clinical case.

Aim: To evaluate the advantages of the retroperitoneal approach in patients with occlusive disease of the aortoiliac segment.

Materials and Methods: Over a two-year period, 40 patients with aortoiliac occlusive disease or aneurysms of the abdominal aorta and iliac arteries were treated at our clinic; 30 underwent a transperitoneal approach and 10 a retroperitoneal approach, all with aorto-bifemoral bypass. All patients in the retroperitoneal-approach group had a history of previous midline laparotomy. We additionally present one illustrative case of a patient with Leriche syndrome, prior midline laparotomy, and a history of bladder neoplasm, in whom an extra-anatomic aorto-bifemoral bypass was performed via a retroperitoneal approach.

Results: Patients were followed for up to three years postoperatively. Mean hospital stay and intensive care unit stay were shorter in the retroperitoneal group than in the transperitoneal group. In the illustrative case, intestinal passage was restored on the second postoperative day, the patient was discharged from intensive care on the second postoperative day, and was discharged from hospital in good general condition with palpable pedal pulses.

Conclusion: Extra-anatomic aorto-bifemoral bypass performed via a retroperitoneal approach is a favorable option in patients with previous laparotomies and oncological disease of the abdominal cavity or pelvis. Patients undergoing the retroperitoneal approach have shorter hospital and intensive care unit stays.

Keywords: Aorto-Bifemoral Bypass; Retroperitoneal Approach; Aortoiliac Occlusive Disease; Extra-Anatomic Bypass; Aorta

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Citation

Citation: Emil Hadzhiev., et al. “Aorto-Bifemoral Bypass via Retroperitoneal Approach: Our Clinic's Experience". Acta Scientific Medical Sciences 10.11 (2026): 40-45.

Copyright

Copyright: © 2026 Emil Hadzhiev., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.