Open and endovascular repair of juxtarenal abdominal aortic aneurysms: a systematic review

Abstract

This systematic review focuses on the 30-day mortality associated with open surgery and fenestrated endografts for short-necked (<15 mm) juxtarenal abdominal aortic aneurysms. A search for studies published in English and indexed in the PubMed and Medline electronic databases from 2002 to 2012 was performed, using “juxtarenal abdominal aortic aneurysm” and “treatment” as the main keywords. Among the 110 potentially relevant studies that were initially identified, eight were in accordance with the inclusion criteria in the analysis. Similar outcomes for open and endovascular repair were observed for 30-day mortality. No differences were observed regarding the secondary outcomes (duration of surgery, hospital stay, postoperative renal dysfunction and late mortality), except that the late mortality rate was significantly higher for the patients treated with open repair after a median follow-up of 24 months. Fenestrated endografting is a viable alternative to conventional surgery in juxtarenal abdominal aortic aneurysms with a proximal neck <15 mm.

Thirty-day outcomes after fenestrated endovascular repair are superior to open repair of abdominal aortic aneurysms involving visceral vessels

“…5,[10][11][12] Although systematic reviews on the subject have recently been published, there is yet to be a prospective randomized trial evaluating the two operative modalities. [13][14][15][16] This study reports current data on 30-day outcomes with FEVAR and OS in AAA-Vs in a multicenter setting that we believe is most indicative of current practice patterns.…”

“…FEVAR is also more expensive than OS (difference due to the increased cost of the graft) and should be considered in a systems-based analysis of the two methods. 10,14 Despite its many strengths, this study has some limitations. Variables analyzed were limited to those recorded by NSQIP.…”

“…Although some studies show no difference in mortality between the two groups, no study has shown decreased mortality with OS compared with FEVAR. 10,[14][15][16] Most studies comparing FEVAR and OS also make note of postoperative renal complications. Our finding that 6.4% of OS patients require dialysis is on the higher end of currently published rates of 1.4% to 6.4% for postoperative dialysis dependence in OS for AAA-Vs. 11,12,15 However, because we only have 30-day data available for our study, our patient population may also include patients who have severe renal injury but will eventually recover enough function to forego long-term dialysis.…”

Developing a new endograft for the treatment of juxtarenal aortic aneurysms: definition and experimentation

“…Endovascular procedures for the treatment of JRA include a hybrid technique, fenestrated or branched endografts, and the chimney technique 5 and are associated with more early and late postoperative complications, and especially renal insufficiency, endoleaks and thrombosis of the stent 6 . Certain authors consider endovascular approaches to be contraindicated for JRA 4 , but a recent systematic review 7 comparing open and endovascular repair of JRA showed promising results for EVAR, with significantly lower rates of two-year mortality compared with open repair (16% and 23%, respectively). However, the rates remain higher than those observed in infrarenal aneurysms with a neck length >15 mm (7.8%) 8 .…”

Thirty-Day Outcomes of Fenestrated and Chimney Endovascular Repair and Open Repair of Juxtarenal, Pararenal, and Suprarenal Abdominal Aortic Aneurysms Using National Surgical Quality Initiative Program Database (2012-2016)

“…Three different systematic reviews on juxtarenal AAA found no difference in mortality between endovascular and OAR, which may be related to the strict inclusion criteria. 7,14,15 Furthermore, these reviews only included studies until 2012 or 2013. Majority of studies on FEVAR including our recent study using NSQIP is recent and is not included in these reviews.…”