The effect of suprarenal cross-clamping on abdominal aortic aneurysm repair
W. L. Breckwoldt, W. C. Mackey, M. Belkin and T. F. O'Donnell Jr
Division of Vascular Surgery, Tufts University, New England Medical Center, Boston, Mass. 02111.
Two hundred five patients who underwent elective abdominal aortic aneurysm
repair were divided into two groups: those who underwent infrarenal
cross-clamping alone (n = 166) and those who underwent suprarenal
cross-clamping alone or combined with infrarenal cross-clamping (n = 39).
Mortality was comparable between groups (1.2% for infrarenal cross-clamping
vs 2.6% for suprarenal cross-clamping). Transient renal insufficiency was
more frequent in the suprarenal group than in the infrarenal group (28% vs
10%), but dialysis rates (3% for suprarenal vs 2% for infrarenal) were
similar. Cardiac morbidity was comparable between groups as well. Operating
room data reflected the technical challenge of complex aneurysm repairs.
The retroperitoneal approach was the preferred exposure in the suprarenal
group since better access to the suprarenal aorta may be achieved with this
technique. While abdominal aortic aneurysm repairs requiring suprarenal
cross-clamping remain a technical challenge, the risks are not formidable
and suprarenal cross-clamping should be considered when confronted with
difficult periaortic dissection.
