Editor's Choice – Durability of Open Repair of Juxtarenal Abdominal Aortic Aneurysms: A Multicentre Retrospective Study in Five French Academic Centres

Abstract

WHAT THIS PAPER ADDS This multicentre study suggests that in fit patients, open juxtarenal abdominal aneurysm repair can be performed with acceptable operative risk and with durable results in terms of both graft integrity and preservation of renal function. Predictors of acute kidney injury (AKI) were pre-existing chronic kidney disease, diabetes, hypertension, and age. The level and duration of renal artery clamping (24 AE 7 min, range 10e55 min) were not associated with an increased risk of AKI in this group of fit patients. Objectives: With a focus on renal function, the goal of this multicentre study was to assess peri-operative complications and late mortality of open surgical repair (OSR) of juxtarenal abdominal aortic aneurysms (JRAAA). Methods: From February 2005 to December 2015, 315 consecutive patients undergoing elective OSR of a JRAAA in five French academic centres were evaluated retrospectively. The definition of JRAAA was an aortic aneurysm extending up to but not involving the renal arteries, i.e., a short neck <10 mm. End points included postoperative death; acute kidney injury (AKI) defined by the RIFLE (Risk, Injury, Failure, Loss of function, End stage renal disease) criteria; and long term follow-up with freedom from chronic renal decline (CRD) and any graft related complications. Factors predictive of renal insufficiency were determined by multivariable analysis. Results: Of 315 patients, 292 (92.6%) were men (mean age 68 AE 8 years), and 73 (23.2%) had baseline chronic kidney disease (CKD) with an estimated glomerular filtration rate of <60 mL/min/1.73 m 2. The level of aortic clamping was supracoeliac (n ¼ 11), suprarenal (n ¼ 235), or inter-renal above one renal artery (n ¼ 69).The mean duration of renal artery clamping was 24 AE 7 min (range 10e55 min). Eleven patients (3.5%) presented with a renal artery stenosis that was treated conservatively. Perfusion of the renal arteries with a chilled Ringer's solution was used selectively in seven patients (2.2%). The overall 30 day mortality was 0.9% (three patients). AKI occurred in 53 patients (16.8%). Nine patients (2.9%) required temporary dialysis and one patient required chronic dialysis. Predictors of AKI were preexisting CKD (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.13e4.48; p ¼ .021], diabetes (OR 3.15, 95% CI 1.48e6.71; p ¼ .003), hypertension (OR 3.38, 95% CI 1.33e8.57; p ¼ .01), and age (OR 1.05, 95% CI 1.01e1.10; p ¼ .014). The level of aortic clamping and duration of renal artery clamping were not associated with an increased risk of AKI. The KaplaneMeier survival estimate was 71% AE 5% at five years. Predictors of CRD during follow up were AKI (hazard ratio [HR] 15.81, 95% CI 5.26e47.54; p ¼ .001), diabetes (HR 4.56, 95% CI 1.57e13.17; p ¼ .005), and pre-existing CKD (HR 2.93, 95% CI 1.19e7.20; p ¼ .019), with freedom from CRD of 89% AE 3% at five years. Surveillance imaging was obtained by computed tomography angiography in 290 patients (92.6%) at a mean follow up of 4.3 AE 2.4 years. Renal artery occlusion occurre...

RETRACTED ARTICLE: Protective effect of vasostatin-1 plasmid-like nanoparticles on aortic aneurysm and its mechanism

“…Aortic aneurysm is the damage to the normal structure of the aortic wall caused by various reasons. Under blood flow pressure, the aortic wall locally or diffusely expands abnormally to more than 1.5 times the normal aortic diameter [ 1 ]. It often occurs in the ascending aorta, aortic arch, descending thoracic aorta, thoracic abdominal aorta, and abdominal aorta.…”

Effects of Suprarenal Aortic Cross-Clamping and Adjunctive Renal Reconstruction on Outcomes of Open Abdominal Aortic Aneurysm Repair

“…In 2009, Chong et al 7) reported that the patients who required SR cross-clamping during open AAA repair had an operative mortality rate of 1.8%, which was similar to the rate of 1.1% that they observed after IR AAA repairs. More recently, Chaufour et al 8) reported that the operative mortality rate following open juxtarenal AAA repair in French high-volume centers was 0.9%.…”

Offene und endovaskuläre Versorgung des infrarenalen vs. juxtarenalen Bauchaortenaneurysmas

“…In einem italienischen Zentrum machte die 30-Tage-Letalität bei OAR von 155 juxtarenalen AAA sogar nur 0,6 % aus, die postoperative Morbidität 10 % [6]. Fünf akademische Zentren aus Frankreich berichteten über eine multizentrische konsekutive Serie von 315 OAR juxtarenaler AAA [3]. In dieser Serie wurden lediglich 3 (0,9 %) Todesfälle postoperativ (30-Tage-Letalität und Klinikletalität eingeschlossen) gesehen, postoperative Komplikationen traten in 14,6 % auf.…”