Abdominal aortic aneurysms: CT evaluation of renal artery involvement.
OBJECTIVE
To determine whether computed tomography (CT) assessment of the proximal extent of ruptured aneurysms can help the surgeon determine whether to initially clamp the pararenal aneurysm neck or the supraceliac aorta.


METHODS
CT scans and medical records were reviewed and compared for 30 patients with ruptured abdominal aortic aneurysms (AAAs) who underwent immediate surgical repair.


RESULTS
For 49 of 50 vessels in 25 patients, the authors correctly predicted at CT that AAAs originated caudal to the main renal artery origins. They also predicted that nine main renal arteries in five patients originated directly from the AAAs, but this was correct in only five arteries. Suprarenal clamping was required in all five patients. Infrarenal clamps were used before reconstruction in all 12 of the patients whose AAAs appeared to originate at least 30 mm below the main renal arteries.


CONCLUSIONS
CT can help predict whether an initial aortic clamp can be placed caudal to the main renal artery orifices. Its use can be predicted with 100% certainty only when an aneurysm appears to originate at least 3 cm caudal to the origin of the main renal artery.
Cohan
R H
RH
Department of Radiology, University of Michigan Medical Center, Ann Arbor 48109.
Siegel
C L
CL
Korobkin
M
M
Stanley
J C
JC
Alpern
M B
MB
Courneya
D L
DL
Leder
R A
RA
D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery; D001019:Aortic Rupture / Q000000981:diagnostic imaging* / Q000601:surgery; D003250:Constriction; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012077:Renal Artery / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed