title: Renal dysfunction and prolonged visceral ischaemia increase mortality rate after suprarenal aneurysm repair.
abstract: BACKGROUND
  Elective juxtarenal abdominal aneurysm repair has a significantly lower mortality rate than suprarenal repair. Identification of factors affecting outcome may lead to a reduction in mortality rate for suprarenal repair.
  
  
  METHODS
  Data were collected prospectively between 1993 and 2000 for 130 patients who underwent type IV thoracoabdominal aneurysm (TAA) repair and 44 patients who had juxtarenal aneurysm (JRA) repair. Preoperative risk factors and operative details were compared between groups and related to outcome after TAA repair (there were only two deaths in the JRA group).
  
  
  RESULTS
  The in-hospital mortality rate was significantly higher following TAA repair (20.0 per cent; 26 of 130 patients) than JRA repair (4.5 per cent; two of 44). Raised serum creatinine concentration was the only preoperative factor (P = 0.013) and visceral ischaemia the only significant operative factor (P = 0.001) that affected mortality after TAA repair.
  
  
  CONCLUSIONS
  JRA repair was performed with similar risks to those of infrarenal aneurysm repair. Impaired preoperative renal function was related to death following TAA repair and conservative treatment should be considered for patients with a serum creatinine level above 180 micromol/l. Reducing the duration of visceral ischaemia might improve outcome.
authors.affiliation: Regional Vascular Unit, Vascular Secretaries Office, Waller Cardiac Building, St Mary's Hospital, Praed Street, London W2 1NY, UK. colin.bicknell@ic.ac.uk
authors.forename: C D
authors.initials: CD
authors.lastname: Bicknell
authors.forename: A R
authors.initials: AR
authors.lastname: Cowan
authors.forename: M I
authors.initials: MI
authors.lastname: Kerle
authors.forename: A O
authors.initials: AO
authors.lastname: Mansfield
authors.forename: N J W
authors.initials: NJ
authors.lastname: Cheshire
authors.forename: J H N
authors.initials: JH
authors.lastname: Wolfe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000401:mortality; D007674:Kidney Diseases / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011300:Preoperative Care; D012307:Risk Factors; D016896:Treatment Outcome; D014781:Viscera / Q000098:blood supply*