Abstract
The authors reviewed the surgical treatment and outcome in patients with juxtarenal aortic occlusion. From 1975 to 1993, 44 patients (37 men) with a mean age of 62.6 years underwent surgery for this condition. The vascular lesions included renal-level segmental aortic occlusion in 2 patients, infrarenal complete aortic occlusion in 30, and high aortic occlusion with a patent inferior mesenteric artery in 12. Four patients had subacute occlusion and 40 had chronic occlusion. In the chronic group, the symptom was intermittent claudication in 31 cases, rest pain in 4, and gangrene or ulceration in 5. Impotence was present in most of the men.
Surgical treatment included transaortic thromboendarterectomy in 2 patients, axillobifemoral bypass in 12, and high aortic thromboendarterectomy plus aortobifemoral bypass in 29. Suprarenal aortic clamping was done in 22 patients, with a mean renal occlusion time of 9.3 minutes. Simultaneous renal artery reconstruction was performed in 3 patients.
There were 4 operative deaths (mortality rate 9%), with 2 in the subacute group. Late death from unrelated causes occurred in 9 patients within five years. Lower limb ischemia was cured in all patients and impotence cured in 4 cases. Graft patency was satisfactory after both extra-anatomic and anatomic bypass. Transanal Doppler ultrasound monitoring during the surgery was easy to set and gave the authors useful information about accurate visceral circulation in reference to aortic reconstruction.
Get full access to this article
View all access options for this article.