The juxtarenal abdominal aortic aneurysm. A more common problem than previously realized?
S. M. Taylor, J. L. Mills and R. M. Fujitani
Department of Surgical Education, Greenville Hospital System, SC.
OBJECTIVE: To determine the incidence and treatment outcome of juxtarenal
infrarenal aneurysmectomy in a vascular practice minimally biased by
tertiary referral. DESIGN: A 5-year retrospective review of all aortic
operations from our vascular registry was performed, and a case series of
juxtarenal aneurysmectomies was analyzed. PATIENTS: Of 174 infrarenal
aortic aneurysmectomies performed, 27 (15.5%) (95% confidence interval,
10.5% to 21.8%) involved the juxtarenal aorta. INTERVENTIONS: Juxtarenal
involvement was unsuspected but found by aortography in 25 (93%) of 27
cases. Resection was performed transabdominally in 20 cases (74%) and
retroperitoneally in seven cases (26%). MAIN OUTCOME MEASURES: Incidence,
operative technique, morbidity, and mortality were analyzed and compared
with those of historical controls. RESULTS: The incidence of juxtarenal
aneurysmectomy was 15.5%. No operative deaths occurred, but there was a 19%
incidence of surgical morbidity (including a 7% incidence of transient
renal failure). The late survival rate was 89% (follow-up, 1 to 53 months;
mean, 18 months). CONCLUSIONS: Juxtarenal aortic aneurysms are not
uncommon. Successful management is possible, even outside the large
referral center.
