Surgical Repair of Juxtarenal Abdominal Aortic Aneurysms and safety of Suprarenal Aortic Clamping

Abstract

Background Juxtarenal abdominal aortic aneurysm (AAA) comprises 15–20% of all AAAs and often requires open surgical repair (OSR) due to anatomical limitations associated with endovascular aneurysm repair (EVAR), particularly in the case of hostile proximal necks. This study aimed to evaluate short‐ and long‐term outcomes of suprarenal clamping during OSR of juxtarenal AAAs and compare the outcomes of this technique with those of infrarenal clamping for AAAs. Methods Between January 1 2014, and December 31 2016, 289 consecutive patients aged ≥40 years underwent primary repair for infrarenal AAAs, including 141 OSRs and 148 EVARs. Of the 141 patients, 20 were excluded and totally, 121 patients were included. Results All patients had fusiform‐type AAAs and were divided into infrarenal (N = 98) or suprarenal (N=23) clamp groups. The mean follow‐up period was 51.4 months (95% CI: 48.6–54.2). Mean survival time was 51.4 months (95% CI: 48.6–54.2). Thirty‐day mortality was 0.8%, and there was no significant difference between two groups (P >. 999). Renal complication in infrarenal clamp group was 4.1% and suprarenal clamp group was 4.3% (P >. 999). Old age (HR: 1.084; 95% CI: 1.025–1.147; P=.005) and high ASA score (HR: 2.361; 95% CI: 1.225–4.553; P =. 010) were substantially associated with in‐hospital complications. Conclusions Although endovascular procedures for repairing juxtarenal AAAs, such as fenestrated EVAR, have been developed, surgical repair is the standard treatment for juxtarenal AAAs. Morbidity and mortality due to open surgery were not higher in the juxtarenal AAA group than in the infrarenal AAA group. Therefore, need for suprarenal clamp should not preclude OSR and also there is continued need for training in surgical exposure of juxtarenal AAA and OSR.

Quality-adjusted life year comparison at medium term follow-up of endovascular versus open surgical repair for abdominal aortic aneurysm in young patients

“…In a study on patients over 40 years of age treated with AAA between 2014 and 2016, the 30-day mortality was 0.8%. This study also discovered that morbidity (including renal complications) and mortality due to OSR were not higher in the suprarenal aortic clamping group than those in the infrarenal aortic clamping group [ 28 ].…”

Nem infrarenalis lokalizációjú hasi aortaaneurysmák miatt végzett nyitott műtétek hosszú távú adatainak elemzése

“…Jeong és mtsai célja a juxtarenalis aneurysmák nyitott műtéti kezelése alatti suprarenalis és infrarenalis aortakirekesztés rövid és hosszú távú eredményeinek összehasonlítása volt. Retrospektív tanulmányukban a 30 napos mortalitás 0,8% volt, és nem találtak szignifikáns különbséget a két csoport között, ugyanúgy, ahogy a vesét érintő szövődmények arányában sem, azonban az időskorú, valamint az altatóorvosi kivizsgálás kapcsán magas ASAkategóriába tartozó páciensek körében több posztoperatív szövődmény fordult elő eredményeik alapján [22].…”