Open repair of aortic aneurysms involving the renal vessels.
This retrospective review examines the open surgical repair of intact juxtarenal (JRAAs) and suprarenal (SRAAs) aortic aneurysms to estimate effects on survival and renal function. Patients undergoing open repair of JRAA and SRAA were identified. Preoperative medical comorbidities and perioperative and late outcomes were recorded. Primary end points were survival (perioperative and long-term survival) and changes in renal function (acute tubular necrosis [ATN], acute dialysis, and late functional decline). Associations between outcomes and clinical variables were examined using univariate and multivariate techniques. Between December 1996 and September 2006, 678 patients underwent open repair of aortic aneurysms, including 150 aneurysms involving the renal vessels (134 JRAAs, 16 SRAAs). Perioperative mortality was 3% and long-term survival was 69% at 5 years. Fourteen percent of patients experienced ATN, and 7% required acute in-hospital dialysis. Late renal function remained unchanged or improved in 75%. These results demonstrate a perioperative mortality and renal complication rate in keeping with previous reports of open abdominal aortic aneurysm repairs involving the renal vessels. Future implementation of branch and fenestrated aortic endografts to treat similar aneurysms should approximate these results prior to widespread acceptance.
Pearce
Jeffrey D
JD
Section on Vascular and Endovascular Surgery, Division of Surgical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1095, USA.
Edwards
Matthew S
MS
Stafford
Jeanette M
JM
Deonanan
Joel K
JK
Davis
Ross P
RP
Corriere
Matthew A
MA
Crutchley
Teresa A
TA
Hansen
Kimberley J
KJ
D000368:Aged; D001014:Aortic Aneurysm / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012077:Renal Artery / Q000601:surgery*; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome