Comparative early and midterm results of open juxtarenal and infrarenal aneurysm repair

Abstract

Open aortic surgery for JRA with the need for suprarenal cross-clamping shows a slightly elevated in-hospital mortality rate without statistical significance and equal midterm mortality results in comparison with infrarenally clamped aortic aneurysms.

Comparable mortality with open repair of complex and infrarenal aortic aneurysm

“…The overall increase in complications associated with CAA was influenced by cardiac, pulmonary, and renal complications with similar rates reported by other investigators. [11][12][13][14][15][25][26][27] This is consistent with the theoretic increase in risk associated with the technical challenges of complex aneurysm repair, a more proximal clamp application and the attendant renal and/or visceral ischemia. Patients undergoing VVR had the highest frequency of major complication, which were also influenced by cardiac, pulmonary, and renal complications (Table VI).…”

“…10 Many single center experiences from high volume centers have reported low mortality and moderate morbidity for complex aneurysm repair; however, these reports are limited by cohort size, and inclusion of data spanning decades of experience. [11][12][13][14][15][16] Jongkind et al 17 recently published a systematic review on outcomes of juxtarenal aneurysm repair. This review collated outcomes from 21 published reports with a total of 1256 patients and concluded that juxtarenal aneurysm repair can be performed with acceptable mortality (2.9%) and that postoperative renal dysfunction is common.…”

Juxtarenal aortic aneurysm repair

“…30 Twenty-three studies described combined results of JAA and SAA repair or surgery for occlusive disease. From 19 studies, specific data on mortality or new onset of dialysis after non-ruptured open JAA repair could not be retrieved and were excluded, [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] resulting in 21 articles to be included in the systematic review. [1][2][3][4][5][6][7][8][9][10]15,[50][51][52][53][54][55][56][57][58][59] The chance adjusted interreviewer agreement for study eligibility (kappa) was 0.77.…”

Renal perfusion with venous blood extends the permissible suprarenal clamp time in abdominal aortic surgery

“…[12][13][14] The incidence of renal failure after suprarenal clamping has been shown to depend on clamp time and is estimated at about 20%, with 3% to 4% requiring permanent dialysis. 1,[15][16][17] The question of nephroprotection as a possible adjunct to improve outcome arises.…”

“…[1][2][3] In the era of endovascular aneurysm repair (EVAR), the relative number of patients presenting for open conventional surgery with a hostile proximal anatomy and frequently pre-existing reduced renal function, increases steadily. [4][5][6] This is because of a number of late conversions, but more important, because of the decreased reluctance to operate on severely comorbid or elderly patients despite clearly rising rates of complications with age.…”