[Justa-renal aortic aneurysms repair: consequences of the supra-renal aortic clamping, based on an experience of 44 operated cases].
The present study is aimed at the evaluation of the consequences of the supra-renal aortic clamping in the surgical management of justa-renal aortic aneurysms, based on a personal experience of 44 cases operated on for the last 25 years. The series includes 42 men (95.5%) and 2 women (4.5%) with an average age of 70 years. All patients were operated on transperitonealy and the transection and reconstruction of left renal vein was made in 15 instances. Supra-renal aortic clamping and renal average ischemic time was 13'3 minutes, and no significant functional renal alterations could be noticed, nor the need for hemodialysis support. Contrarily, significant occlusive lesions of the renal arteries (4 instances) or the superior mesenteric artery (1 case) resulted as a mechanical consequences of the supra-renal aortic clamping. Three cases were recognized and repaired intraoperatively, through renal revascularization, one case was not diagnosed, coursed with anuric renal failure and death (mortality 2.2%). Patient with mesenteric artery occlusion developed an acute mesenteric ischemia which was successfully managed conservatively. The author concludes by enhancing the risks of the mechanical consequences arising from the supra-renal aortic clamping, namely renal or mesenteric ischemia. Its prompt recognition and repair seems mandatory, in order to avoid the severe and even fatal consequences that it may cause, raising the morbi-mortality rates that sometimes accompanies the surgical management of justa-renal aortic aneurysms.
Dinis da Gama
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Clinica Universitária de Cirurgia Vascular do Hospital de Santa Maria, Lisboa.
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D003250:Constriction; D005260:Female; D006801:Humans; D007668:Kidney; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods