title: Circumferential Aortic Endarterectomy Followed with Immediate Infrarenal Clamping Obviates Suprarenal Clamping for Juxtarenal Aortoiliac Occlusion.
abstract: BACKGROUND
  Traditional open surgery for juxtarenal aortoiliac occlusive disease (AIOD) requires suprarenal aortic cross-clamping (SRCC), which is associated with high incidence of acute kidney injury (AKI). This study was to compare the outcomes of circumferential aortic endarterectomy followed by immediate infrarenal cross-clamping (IRCC) with the traditional approach of SRCC during surgery for juxtarenal AIOD.
  
  
  METHODS
  A 10-year retrospective review of 87 patients who underwent open surgery for AIOD at our University Medical Center was performed. There were 52 males and 35 females (mean age of 52 years). Multivariate analysis was performed to assess operative time, blood loss, incidence of AKI, 30-day mortality, and recurrent aneurysm/pseudoaneurysm.
  
  
  RESULTS
  Thirty-seven patients were found to have juxtarenal AIOD, which were divided into SRCC (n = 25) and IRCC (n = 12). Ten patients from the SRCC developed AKI versus 1 from the IRCC (30% vs. 8.3%, P = 0.04). SRCC demonstrated increased blood loss (1,681 vs. 591 mL, P = 0.004). Mean operative time was less in the IRCC group (5 vs. 7 hr, P = 0.0001). Thirty-day mortality in the SRCC group was 1 and 0 in the IRCC group, respectively. Recurrent aneurysm or pseudoaneurysm was not identified in endarterectomized aorta up to 4-year follow-up.
  
  
  CONCLUSIONS
  Circumferential aortic endarterectomy followed with immediate IRCC is a feasible, safe, and effective approach for juxtarenal AIOD in properly selected patients. It may be associated with lower rates of AKI, intraoperative bleeding, operating room time, and length of hospital stay, when compared with the traditional SRCC.
authors.affiliation: Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Pearce
authors.affiliation: Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA.
authors.forename: Shu
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA.
authors.forename: Runhua
authors.initials: R
authors.lastname: Shi
authors.affiliation: Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA.
authors.forename: Tze-Woei
authors.initials: TW
authors.lastname: Tan
authors.affiliation: Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. Electronic address: wzhan2@lsuhsc.edu.
authors.forename: Wayne W
authors.initials: WW
authors.lastname: Zhang
mesh_terms: D000046:Academic Medical Centers; D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016063:Blood Loss, Surgical; D000072226:Computed Tomography Angiography; D003250:Constriction; D004691:Endarterectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome