Juxtarenal Abdominal Aortic Aneurysm: Results Of Open Surgery In An Academic Center.Ann Vasc Surg 2019AV
To report our experience with conventional surgery for juxtarenal abdominal aortic aneurysms (JRA) by evaluating incidence of acute renal failure and perioperative mortality. Secondary objectives are to evaluate general morbidity, the need for permanent postoperative dialysis, and to assess the influence on long-term survival of preoperative risk factors and deterioration of perioperative renal function.
A retrospective cohort study of 110 JRA patients electively treated by open surgery between March 1992 and March 2018 was made. Data was obtained from clinical records, describing demographics, perioperative variables and results. Acute kidney injury (AKI) was defined as 50% decrease in glomerular filtration rate (GFR) or two-fold increase in serum creatinine. Multivariate analysis was performed by logistic regression to establish risk factors for renal failure. The influence of preoperative risk factors and deterioration of perioperative renal function on long-term survival was studied using Cox regression model. Descriptive and inferential statistics were used in the analysis.
110 consecutive patients were treated with an average age of 71 years, 82.7% male; 81% hypertensive and 41% active smokers. 46.3% had stage III or higher preoperative chronic kidney disease (CKD). Median diameter of the aneurysm was 5.7 cm. Interruption of bilateral renal flow was required in 73 patients (66.4%) and unilateral in 37 (33.6%). The average renal clamping time was 34.5 minutes. AKI occurred in 9 patients (8.2%). Two patients (1.8%) required postoperative dialysis, one of them permanent. Median hospital stay was 7 days. Thirty-three patients (30%) had at least one complication. Postoperative mortality was 2.7% (3 patients), two of them developed AKI. Multivariate analysis established a longer operative time and need for renal revascularization as independent risk factors for AKI. In the survival analysis, age, cerebrovascular disease, COPD and perioperative AKI, were identified as risk factors for long-term mortality.
JRA open surgical repair can be performed with low morbidity and mortality. Although transient acute renal dysfunction may be relatively frequent, the need for hemodialysis is low. Our study is a reference point to compare with endovascular repair.