title: Comparison of supramesenteric aortic cross-clamping with supraceliac aortic cross-clamping for aortic reconstruction.
abstract: OBJECTIVE
  Supraceliac aortic cross-clamping (SCXC) is routinely used during open aortic reconstruction (OAR) of pararenal aortic disease when suprarenal control is not feasible. On occasion, however, aortic control may be obtained at the supramesenteric level by supramesenteric cross-clamping (SMXC) between the superior mesenteric artery and the celiac axis. The purpose of this study was to compare outcomes between patients who had SMXC vs SCXC during OAR for both aneurysmal and occlusive diseases.
  
  
  METHODS
  A retrospective chart review identified 69 patients who underwent elective OAR requiring SMXC (n = 18) or SCXC (n = 51). All patients with thoracoabdominal aneurysms and those who had inframesenteric (suprarenal and infrarenal) aortic control were excluded. Propensity score-based matching was performed to adjust for confounding factors in a 1:1 ratio to compare outcomes. Late survival was estimated by Kaplan-Meier methods.
  
  
  RESULTS
  Propensity score-based matching was performed at a 1:1 ratio; 18 SMXC cases were matched with 18 SCXC cases. The average age was 66.7 years, and men constituted 72%. Baseline characteristics were matched, except for the incidence of peripheral vascular occlusive disease (72.2% in the SMXC group vs 33.3% in the SCXC group; P = .04). A majority (80.6%) of patients underwent OAR for aneurysmal disease (72.2% in the SMXC group, 88.9% in the SCXC group). Intraoperatively, there were no differences in operative times (325 minutes for SMXC vs 298 minutes for SCXC; P = .48), but the SMXC group had a longer renal ischemia time (40 minutes vs 28 minutes; P = .03). There were no significant differences in intraoperative blood loss (2.4 L vs 1.6 L; P = .2) or blood product transfusion requirements (packed red blood cells, 2.2 units vs 1.6 units [P = .5]; Cell Saver, 1.3 L vs 0.7 L [P = .09]). Overall complication rates did not differ significantly (27.8% for SMXC vs 44.4% for SCXC; P = .24). Thirty-day mortality rates did not differ between the two groups (0% for SMXC vs 5.6% for SCXC; P = 1).
  
  
  CONCLUSIONS
  In this study, there were no differences in early morbidity or mortality between SMXC and SCXC during aortic reconstruction. SMXC, however, can be performed safely and effectively in properly selected patients. A larger, multicenter prospective study would help elucidate the potential benefits.
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, Ill.
authors.forename: Sungho
authors.initials: S
authors.lastname: Lim
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, Ill.
authors.forename: Pegge M
authors.initials: PM
authors.lastname: Halandras
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Houston Medical Center, Houston, Tex.
authors.forename: Naveed U
authors.initials: NU
authors.lastname: Saqib
authors.affiliation: Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Tex.
authors.forename: Y Avery
authors.initials: YA
authors.lastname: Ching
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, Ill.
authors.forename: Edward
authors.initials: E
authors.lastname: Villella
authors.affiliation: Department of Applied Statistics, Yonsei University, Seoul, Korea.
authors.forename: Taeyoung
authors.initials: T
authors.lastname: Park
authors.affiliation: Department of Applied Statistics, Yonsei University, Seoul, Korea.
authors.forename: Hyunju
authors.initials: H
authors.lastname: Son
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, Ill. Electronic address: jschomd@icloud.com.
authors.forename: Jae S
authors.initials: JS
authors.lastname: Cho
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016063:Blood Loss, Surgical; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D003250:Constriction; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D057216:Propensity Score; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome