The Feasibility of Using Parietal Peritoneum Aponeurotic Tissue as a Vascular Substitute in Aortic Reconstruction: An Anatomical and Histological Study

Background Autologous materials are preferred for vascular reconstruction in infected fields due to their resistance to infection. Venous conduits such as the saphenous or femoral veins are commonly used, their harvest is associated with significant morbidities, including prolonged operative time. The parietal peritoneum–aponeurotic tissue (PPAT), accessible during a transperitoneal approach, may represent an alternative autologous graft material. Objective To evaluate the anatomical feasibility and histological characteristics of PPAT as a vascular substitute for aortic reconstruction. Methods Six cadavers underwent midline transperitoneal dissection, with harvest of the posterior rectus sheath and parietal peritoneum. Tissue dimensions were measured across three predefined zones, and tubular graft reconstruction was simulated over a 20-ml syringe (≈ 20 mm diameter). The criterion for judging the feasibility of performing an aortic graft was chosen: the diameter of the PPAT tube greater than 20 mm. Histological evaluation was performed with standard staining techniques to assess collagen, elastic fibers, and overall tissue architecture. Results The mean PPAT length was 12.6 ± 1.3 cm, that sufficient to construct tubular graft equal to 23 mm in diameter. Histology confirmed two layers: a mesothelial peritoneal layer and a strong aponeurotic layer containing organized collagen bundles and elastic laminae, resembling arterial wall structure. The tissue was vascularized and innervated, with minimal adipose infiltration; focal degenerative changes were occasionally observed near the umbilicus. Conclusion PPAT can be harvested in adequate dimensions and demonstrates histological features supportive of vascular substitution. It represents a feasible autologous alternative for aortic reconstruction espesilly in infected fields, potentially reducing operative time and avoiding donor-site morbidity. Further biomechanical and clinical studies are required to validate its performance.