title: Results of open pararenal abdominal aortic aneurysm repair: single centre series and pooled analysis of literature.
abstract: Objectives Endovascular treatment of pararenal abdominal aortic aneurysm has gained terrain over the past decade, despite the substantial need for reinterventions during follow-up. However, open repair is still a well-established treatment option. With the current study we report the results of a consecutive series of elective primary open pararenal abdominal aortic aneurysm repair in a tertiary vascular referral centre, combined with an overview of current literature and pooled data analysis of perioperative mortality of open and endovascular pararenal abdominal aortic aneurysm repair. Methods A retrospective analysis of a prospective database of all elective open pararenal abdominal aortic aneurysm repairs in the St. Antonius Hospital between 2005 and 2014 was performed. Primary endpoint was 30-day mortality. Secondary endpoints were 30-day morbidity, new onset dialysis, reintervention free survival, and overall survival during follow-up. Results Between 2005 and 2014, 214 consecutive patients underwent elective open pararenal abdominal aortic aneurysm repair. Mean age was 69.8 (±7.1) years, 82.7% (177/214) were men, and mean abdominal aortic aneurysm diameter was 62 (±11) mm. Thirty-day mortality was 3.4%. Thirty-day morbidity was 27.1%, which predominantly consisted of pneumonia (18.7% (40/214)), cardiac events (3.3% (7/214)), and new onset dialysis (2.8% (6/214)). Estimated five-year overall survival rate was 74.2%. 0.9% (2/214) of patients required abdominal aortic aneurysm-related reintervention, and an additional 2.3% (5/214) required surgical repair of an incisional hernia. Pooled analysis of literature revealed a 30-day mortality of 3.0% for open pararenal repair and 1.9% for fenestrated endovascular repair. Conclusion Open pararenal abdominal aortic aneurysm repair in the era of increasing endovascular options results in acceptable perioperative morbidity and mortality rates. Mid-term reintervention rate is low compared to fenestrated endovascular aneurysm repair. Expertise with open repair still remains essential for treatment of pararenal abdominal aortic aneurysms in the near future, especially for those patients that are declined for endovascular treatment.
authors: 1 Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors: Guus W
authors: GW
authors: van Lammeren
authors: 1 Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors: Çağdaş
authors: Ç
authors: Ünlü
authors: 1 Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors: Sjoerd
authors: S
authors: Verschoor
authors: 2 Department of Anaesthesiology, Intensive Care and Pain Therapy, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors: Eric P
authors: EP
authors: van Dongen
authors: 1 Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors: Jan
authors: J
authors: Wille
authors: 1 Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors: Eric Dwm
authors: ED
authors: van de Pavoordt
authors: 1 Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors: Debbie Ab
authors: DA
authors: de Vries-Werson
authors: 1 Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors: Jean-Paul Pm
authors: JP
authors: De Vries
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016208:Databases, Factual; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: Pararenal abdominal aortic aneurysm; aneurysm; fenestrated endovascular aneurysm repair; open repair