Juxtarenal Aortic Aneurysm Repair

Abstract

Juxtarenal aortic aneurysm (JRAA) is an unusual, but not rare, pattern of aneurysmal disease of the abdominal aorta in which dilatation extends up to, but does not involve, the renal arteries. The objective of this report was to retrospectively analyze experience with JRAA repair at a tertiary referral center over a 5-year period. From November 1990 through December 1995, 12 consecutive patients underwent repair of JRAA by a single surgeon. There were six men and six women, ranging in age from 65 to 82 years (mean = 77 +2 years). All patients underwent preoperative imaging by aortography, ultrasound, or computed transaxial tomographic (CTT) scanning. Mean aneurysm diameter was 6.6 ± 0.3 cm. Three of the aneurysms were ruptured; however, the rupture was contained within the retroperitoneum and hemodynamic stability was maintained. Eleven aneurysms were approached transperitoneally and one retroperitoneally. Aortic clamping was at the suprarenal level in seven instances and at the supraceliac level in five instances. The left renal vein was divided to facilitate exposure in three instances. Warm renal ischemia time was 27 ± 2 minutes. Eight straight and four bifurcation grafts were placed. All patients survived 30 days. Preoperative creatinine was 1.2 ± 0.1 mg/dL. Creatinine peaked on postoperative day 4 at 1.6 ± 0.2 mg/dL and was 1.5 ± 0.3 mg/dL on postoperative day 10. In no instance was temporary dialysis necessary in the postoperative period, nor did chronic renal failure occur. Postoperative CTT scanning in one patient presenting with a ruptured JRAA revealed an infarcted and nonfunctioning left kidney. In the three patients in whom the left renal vein was divided, mean creatinine was 1.1 ± 0.1 mg/dL preoperatively and 0.9 ± 0.2 mg/dL at discharge. JRAA repair can be safely performed by aortic clamping at the suprarenal and supraceliac level. These maneuvers are well tolerated and provide the exposure necessary to facilitate aortic anastomosis at the juxtarenal level.