Durability of open repair of juxtarenal abdominal aortic aneurysms

Tsai, Shirling; Conrad, Mark F.; Patel, Virendra I.; Kwolek, Christopher J.; LaMuraglia, Glenn M.; Brewster, David C.; Cambria, Richard P.

doi:10.1016/j.jvs.2011.12.085

Cited by 66 publications

(55 citation statements)

References 32 publications

(35 reference statements)

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“…This patient had JRO, had a prior history of renal failure and was one of the cases also treated with renal revascularization. Some other studies have reported low rates of patients requiring hemodialysis during the postoperative period; 18,25 while others report that up to 10% of patients with prior renal dysfunction subjected to surgery on the juxtarenal aorta required hemodialysis afterwards. 26 West Jr et al 1 reported that 4.1% of patients with CAIO temporarily required hemodialysis during the postoperative period.…”

Section: Discussionmentioning

confidence: 97%

“…Other studies have reported good rates of mortality and morbidity after surgery on the aorta involving suprarenal clamping. 18,19 West Jr et al 1 reported an 18.9% rate of renal dysfunction after surgery on patients with CAIO. In four patients with JRO, we were able to employ brief suprarenal clamping to conduct manual juxtarenal thrombectomy, before replacing the clamp in an infrarenal position in order to construct the proximal anastomosis.…”

Section: Discussionmentioning

confidence: 99%

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Surgical treatment of chronic aortoiliac occlusion

et al. 2015

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Background: Chronic aortoiliac occlusion (CAIO) is a significant cause of lower limb ischemia and is often found in young patients who smoke. Objective: To review recent results achieved treating CAIO patients with open surgery. Methods: From November 2011 to April 2014, 21 patients with CAIO were treated at the Santa Casa de Misericórdia, Porto Alegre, Brazil. Demographic data, comorbidities, clinical presentation and surgical results were analyzed. Results: Eleven women and ten men were treated with direct aortic bypass (DAB; n=18) or with extra-anatomic bypass (EAD; n=3). Mean age was 53.7 ± 7.3 years (range: 43-79 years) and all patients smoked. Thirteen patients (62%) had critical ischemia. Six of the patients treated with DAB (33.4%) also required additional revascularization (3 renal and 3 femoropopliteal procedures). Perioperative mortality was zero. Four patients (22.2%) suffered transitory renal dysfunction, but only one patient (5.6%) required hemodialysis. Median follow-up time was 17 months (range: 2-29 months) and there was just one late death, from ischemic heart disease, 7 months after the surgery on the abdominal aorta. Conclusions: Aortic reconstruction is a safe method for treating patients with CAIO, with low perioperative morbidity and mortality rates.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Surgical treatment of chronic aortoiliac occlusion

et al. 2015

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“…Patients with juxtarenal or thoracoabdominal aortic aneurysms who either do not have access to a center providing FEVAR or parallel stent graft repairs, or who do not qualify for a FEVAR should be offered an open repair if their comorbidities are not prohibitive. Tsai, et al, provided outcomes on 199 open juxtarenal AAA repairs over an approximate 6-year period, with graft-related complications occurring in only 2 % at 40 months, thus setting a benchmark for juxtarenal AAA repair [14]. And while an endograft repair may be prudent for a particular patient, patient compliance should be considered with regard to postoperative endograft surveillance.…”

Section: The Role Of Open Surgical Repair In Contemporary Practicementioning

confidence: 99%

Management of Aortic Aneurysms: Is Surgery of Historic Interest Only?

2015

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Since its advent in 1991, endovascular aortic aneurysm repair (EVAR) has become a mainstay of treatment for abdominal aortic aneurysms (AAA). Studies such as the comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR 1) trial, have demonstrated the effectiveness of EVAR in reducing perioperative mortality. Technological improvements in graft design and delivery account for an increasing utilization of endovascular repair. Newer branch and fenestrated graft designs have allowed for treatment of patients with complex aortic anatomy that previously could not be treated with EVAR. Endovascular repair, while dominant, is unlikely to eliminate the need for open repair or to relegate open surgery for AAA to historical interest only. The unprecedented adoption of EVAR has led to complications and modes of failure that were not seen with open repair. The rate of failure is markedly increased when endografts are used outside of the instructions for use (IFU). The long-term durability of fenestrated and investigational branch devices remains to be established. The demand for an endovascular approach by patients and the willingness of physicians to place endografts outside the anatomic IFU criteria may have resulted in the pendulum swinging too far away from open surgical management. The consequence of reduced open aortic surgeries is a concern for both patient care as well as training for vascular surgery fellows. Vascular surgery training programs will require innovative changes in training to assure that vascular surgery trainees will have the requisite skill and experience required to competently perform open surgical repair on what will undoubtedly be some of the most complex aortic pathology.

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“…In particular, these technical difficulties pose an increased risk of mortality and morbidity for patients with a history of laparotomy; comorbidities such as coronary artery disease; renal insufficiency; history of steroid use; and chronic obstructive pulmonary disease. 11,12) Recent reports of the open repair of JAA have revealed that the perioperative mortality ranges from 2.5 % to 6.3 %. [12][13][14] The endovascular approach is expected to be beneficial to treat JAA in the high risk patients.…”

Section: Follow-upmentioning

confidence: 99%

“…11,12) Recent reports of the open repair of JAA have revealed that the perioperative mortality ranges from 2.5 % to 6.3 %. [12][13][14] The endovascular approach is expected to be beneficial to treat JAA in the high risk patients. An alternative method for the use of a standard EVAR device for JAA is the "chimney" or "snorkel" technique, which preserves the renal arteries in stent-graft sealing zones.…”

Section: Follow-upmentioning

confidence: 99%