Juxtarenal Aortic Aneurysm Repair

Abstract

U Juxtarenal aortic aneurysm (JRAA) is an unusual, but not rare, pattern of aneurysmal disease of the abdominal aorta in which dilatation extends up to, but does not involve, the renal arteries. The objective of this report was to retrospectively analyze experience with JRAA repair at a tertiary referral center over a 5-year period. From November 1990 through December 1995, 12 consecutive patients underwent repair of JRAA by a single surgeon. There were six men and six women, ranging in age from 65 to 82 years (mean = 77 +2 years). All patients underwent preoperative imaging by aortography, ultrasound, or computed transaxial tomographic (CTT) scanning. Mean aneurysm diameter was 6.6 ± 0.3 cm. Three of the aneurysms were ruptured; however, the rupture was contained within the retroperitoneum and hemodynamic stability was maintained. Eleven aneurysms were approached transperitoneally and one retroperitoneally. Aortic clamping was at the suprarenal level in seven instances and at the supraceliac level in five instances. The left renal vein was divided to facilitate exposure in three instances. Warm renal ischemia time was 27 ± 2 minutes. Eight straight and four bifurcation grafts were placed. All patients survived 30 days. Preoperative creatinine was 1.2 ± 0.1 mg/dL. Creatinine peaked on postoperative day 4 at 1.6 ± 0.2 mg/dL and was 1.5 ± 0.3 mg/dL on postoperative day 10. In no instance was temporary dialysis necessary in the postoperative period, nor did chronic renal failure occur. Postoperative CTT scanning in one patient presenting with a ruptured JRAA revealed an infarcted and nonfunctioning left kidney. In the three patients in whom the left renal vein was divided, mean creatinine was 1.1 ± 0.1 mg/dL preoperatively and 0.9 ± 0.2 mg/dL at discharge. JRAA repair can be safely performed by aortic clamping at the suprarenal and supraceliac level. These maneuvers are well tolerated and provide the exposure necessary to facilitate aortic anastomosis at the juxtarenal level.

Experience in the United States with intact abdominal aortic aneurysm repair

“…6,7,10,11 Several additional features of the study merit further comment. The annual number of nonruptured AAA repairs reported is consistent with a 20% United States sample and within the range reported by Lawrence et al (32,389) and the Center of Disease Control (30,000, ICD-9 code 38.44). 37 The accuracy of the discharge abstract is contingent on the abstracters and coders.…”

“…The sex difference in outcome may also have been due to an increased incidence of suprarenal aneurysms among women. 31,32 Our data also suggest that there was a significant racial difference in outcome. Dardik et al 7 reported similarly that the LOS, hospital charges, and mortality as determined with univariate analysis were all significantly greater for black patients although the difference in mortality also dropped out of their multivariate model.…”

The impact of gender on presentation, therapy, and mortality of abdominal aortic aneurysm in the United States, 2001-2004

“…2 Similarly, in 2001, Huber et al, published data from the NIS (1994)(1995)(1996) showing an increased mortality rate for women as well, citing data for a potentially higher, unmeasured, percentage of juxtarenal aneurysms in the female population as one possible explanation. 10,23,24 The gender-related differences in mortality outcomes observed in the current study are not readily explained by the data. While women, on average, were older than men for both iAAA and rAAA, and age was an independently predictive of higher mortality rates for both groups, patient age was included in the multivariate logistic regression.…”

Juxtarenal aortic aneurysm repair

“…23,24 One study was excluded because it reported on a small case series. 25 We excluded four articles because they reported on JAA and thoracoabdominal aortic aneurysm repair, and data for JAA could not be retrieved. [26][27][28][29] One study described only infrarenal aortic aneurysm repair and was excluded.…”