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Durability of open repair of juxtarenal abdominal aortic aneurysms.
J Vasc Surg. 2012 Jul; 56(1):2-7.JV

Abstract

OBJECTIVE

As branched/fenestrated endografts expand endovascular options for juxtarenal abdominal aortic aneurysms (JAAAs), long-term durability will be compared to that of open JAAA repair, which has not been documented in large contemporary series. The goal of this study was to assess the late clinical and anatomic outcomes after open JAAA repair.

METHODS

From July 2001 to December 2007, 199 patients underwent open elective JAAA repair, as defined by a need for suprarenal clamping. End points included perioperative and late survival, long-term follow-up of renal function, and freedom from graft-related complications. Factors predictive of survival were determined by multivariate analysis.

RESULTS

The mean patient age was 74 years, 71% were men, and 20% had baseline renal insufficiency (Cr >1.5). Thirty-seven renal artery bypasses, for anatomic necessity or ostial stenosis, were performed in 36 patients. Overall 30-day mortality was 2.5%. Four patients (2.0%) required early dialysis; one patient recovered by discharge. Two additional patients progressed to dialysis over long-term follow-up. There was one graft infection involving one limb of a bifurcated graft. Surveillance imaging was obtained in 101 patients (72% of survivors) at a mean follow-up of 41 ± 28 months. Renal artery occlusion occurred in four patients (3% of imaged renal arteries; one native/three grafts). Two patients (2.0%) had aneurysmal degeneration of the aorta either proximal or distal to the repaired segment, but there were no anastomotic pseudoaneurysms. Remote aneurysms were found in 29 patients (29% of imaged patients), 14 of whom had descending thoracic aneurysm or TAAA. Four patients underwent subsequent thoracic endovascular aneurysm repair (TEVAR). Actuarial survival was 74 ± 3.3% at 5 years. Negative predictors of survival included increasing age at the time of operation (relative risk [RR], 1.05; P = .01), steroid use (RR, 2.20; P = .001), and elevated preoperative creatinine (RR, 1.73; P = .02).

CONCLUSIONS

Open JAAA repair yields excellent long-term anatomic durability and preserves renal function. Perioperative renal insufficiency occurs in 8.5% of patients, but few of them progress to dialysis. Graft-related complications are rare (2% at 40 months); however, axial imaging revealed descending thoracic aneurysms in 14% of imaged patients, making continued surveillance for remote aneurysms prudent. These data provide a benchmark against which fenestrated/branched endovascular aneurysm repair (EVAR) outcomes can be compared.

Authors+Show Affiliations

Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22534029

Citation

Tsai, Shirling, et al. "Durability of Open Repair of Juxtarenal Abdominal Aortic Aneurysms." Journal of Vascular Surgery, vol. 56, no. 1, 2012, pp. 2-7.
Tsai S, Conrad MF, Patel VI, et al. Durability of open repair of juxtarenal abdominal aortic aneurysms. J Vasc Surg. 2012;56(1):2-7.
Tsai, S., Conrad, M. F., Patel, V. I., Kwolek, C. J., LaMuraglia, G. M., Brewster, D. C., & Cambria, R. P. (2012). Durability of open repair of juxtarenal abdominal aortic aneurysms. Journal of Vascular Surgery, 56(1), 2-7. https://doi.org/10.1016/j.jvs.2011.12.085
Tsai S, et al. Durability of Open Repair of Juxtarenal Abdominal Aortic Aneurysms. J Vasc Surg. 2012;56(1):2-7. PubMed PMID: 22534029.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Durability of open repair of juxtarenal abdominal aortic aneurysms. AU - Tsai,Shirling, AU - Conrad,Mark F, AU - Patel,Virendra I, AU - Kwolek,Christopher J, AU - LaMuraglia,Glenn M, AU - Brewster,David C, AU - Cambria,Richard P, Y1 - 2012/04/24/ PY - 2011/10/17/received PY - 2011/12/19/revised PY - 2011/12/30/accepted PY - 2012/4/27/entrez PY - 2012/4/27/pubmed PY - 2012/9/21/medline SP - 2 EP - 7 JF - Journal of vascular surgery JO - J Vasc Surg VL - 56 IS - 1 N2 - OBJECTIVE: As branched/fenestrated endografts expand endovascular options for juxtarenal abdominal aortic aneurysms (JAAAs), long-term durability will be compared to that of open JAAA repair, which has not been documented in large contemporary series. The goal of this study was to assess the late clinical and anatomic outcomes after open JAAA repair. METHODS: From July 2001 to December 2007, 199 patients underwent open elective JAAA repair, as defined by a need for suprarenal clamping. End points included perioperative and late survival, long-term follow-up of renal function, and freedom from graft-related complications. Factors predictive of survival were determined by multivariate analysis. RESULTS: The mean patient age was 74 years, 71% were men, and 20% had baseline renal insufficiency (Cr >1.5). Thirty-seven renal artery bypasses, for anatomic necessity or ostial stenosis, were performed in 36 patients. Overall 30-day mortality was 2.5%. Four patients (2.0%) required early dialysis; one patient recovered by discharge. Two additional patients progressed to dialysis over long-term follow-up. There was one graft infection involving one limb of a bifurcated graft. Surveillance imaging was obtained in 101 patients (72% of survivors) at a mean follow-up of 41 ± 28 months. Renal artery occlusion occurred in four patients (3% of imaged renal arteries; one native/three grafts). Two patients (2.0%) had aneurysmal degeneration of the aorta either proximal or distal to the repaired segment, but there were no anastomotic pseudoaneurysms. Remote aneurysms were found in 29 patients (29% of imaged patients), 14 of whom had descending thoracic aneurysm or TAAA. Four patients underwent subsequent thoracic endovascular aneurysm repair (TEVAR). Actuarial survival was 74 ± 3.3% at 5 years. Negative predictors of survival included increasing age at the time of operation (relative risk [RR], 1.05; P = .01), steroid use (RR, 2.20; P = .001), and elevated preoperative creatinine (RR, 1.73; P = .02). CONCLUSIONS: Open JAAA repair yields excellent long-term anatomic durability and preserves renal function. Perioperative renal insufficiency occurs in 8.5% of patients, but few of them progress to dialysis. Graft-related complications are rare (2% at 40 months); however, axial imaging revealed descending thoracic aneurysms in 14% of imaged patients, making continued surveillance for remote aneurysms prudent. These data provide a benchmark against which fenestrated/branched endovascular aneurysm repair (EVAR) outcomes can be compared. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/22534029/Durability_of_open_repair_of_juxtarenal_abdominal_aortic_aneurysms_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(12)00078-X DB - PRIME DP - Unbound Medicine ER -