Early and long-term results in the surgical treatment of juxtarenal and pararenal aortic aneurysms

Objective: Surgical treatment of juxtarenal and pararenal aortic aneurysms (JPAA) provide technical problems which may influence short-and long-term results; however few surgical series have been published on this subject. The purpose of this study is to observe predictors of results in a series of JPAA and to analyse long-term survival of these patients. Design, materials and methods: Patients' epidemiology and surgical technique used in all cases of JPAA were reviewed and correlated with early results through logistic regression analysis. Early results were compared with those of infrarenal aneurysms (IAA) treated in the the same period. Long-term results were obtained through our surveillance protocol (3 months after surgery and yearly thereafter) and calculated by life-table analysis. Results: Fifty JPAA were identified over a total of 1450 aortic aneurysms (3.4%). Surgical approach was: anterior transperitoneal in 38 cases (96%), extended retroperitoneal in one (2%) and thoracoabdominal in one (2%). Suprarenal control was obtained in all cases; at the diaphragm in seven (14%), above both renal arteries in 17 (34%) and above one renal artery in 16 cases (32%). Renal revascularisation was performed in 11 cases (22%; nine unilateral and two bilateral). Overall perioperative mortality teas 22%, significantly greater than mortality of IAAs: 50/1400, 3.5% (p<0.02). Mortality in elective cases was 3/42, 7.1% and in ruptured JPAA 3/8, 37.5%. Independent predictors of early mortality were aneurysm rupture, age >70 years, and coronary artery disease. Gender, smoking, hypertension, diabetes mellitus, site of proximal aortic clamping, type of aortic reconstruction, visceral revascularisation, and technically difficult cases were not associated with early mortality. Three and five year survivals were 66.8% +/- 9.93 and 40.0% +/- 12.64, respectively Conclusions: Surgical treatment of JPAAs is associated with a higher risk of early mortality compared to IAAs and reduced long-term survival. Indications for surgery in JPAAs should consider the risk/benefit ratio rather than focusing an technical aspects which do not seem to significantly influence results.