Open repair of juxtarenal aortic aneurysms (JAA) remains a safe option in the era of fenestrated endografts

Knott, Andrew W.; Kalra, Manju; Duncan, Audra A.; Reed, Nanette R.; Bower, Thomas C.; Hoskin, Tanya L.; Oderich, Gustavo S.; Gloviczki, Péter

doi:10.1016/j.jvs.2007.12.007

Cited by 151 publications

(149 citation statements)

References 27 publications

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“…3 Other reports also showed low mortality and technical factors as strong predictors of postoperative renal insufficiency: prolonged operative time, renal ischemic time, clamp position, and left renal vein division. 4, 14 Contrary to those results, we found that by matching the control group, suprarenal aortic cross-clamping had only a slight adverse effect on postoperative renal function.…”

Section: Discussioncontrasting

confidence: 89%

Effect of Suprarenal Aortic Cross-Clamping

Hoshina

Nemoto

Shigematsu

et al. 2014

Circ J

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Section: Discussioncontrasting

confidence: 89%

Effect of Suprarenal Aortic Cross-Clamping

Hoshina

Nemoto

Shigematsu

et al. 2014

Circ J

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“…This patient had JRO, had a prior history of renal failure and was one of the cases also treated with renal revascularization. Some other studies have reported low rates of patients requiring hemodialysis during the postoperative period; 18,25 while others report that up to 10% of patients with prior renal dysfunction subjected to surgery on the juxtarenal aorta required hemodialysis afterwards. 26 West Jr et al 1 reported that 4.1% of patients with CAIO temporarily required hemodialysis during the postoperative period.…”

Section: Discussionmentioning

confidence: 97%

Surgical treatment of chronic aortoiliac occlusion

et al. 2015

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Background: Chronic aortoiliac occlusion (CAIO) is a significant cause of lower limb ischemia and is often found in young patients who smoke. Objective: To review recent results achieved treating CAIO patients with open surgery. Methods: From November 2011 to April 2014, 21 patients with CAIO were treated at the Santa Casa de Misericórdia, Porto Alegre, Brazil. Demographic data, comorbidities, clinical presentation and surgical results were analyzed. Results: Eleven women and ten men were treated with direct aortic bypass (DAB; n=18) or with extra-anatomic bypass (EAD; n=3). Mean age was 53.7 ± 7.3 years (range: 43-79 years) and all patients smoked. Thirteen patients (62%) had critical ischemia. Six of the patients treated with DAB (33.4%) also required additional revascularization (3 renal and 3 femoropopliteal procedures). Perioperative mortality was zero. Four patients (22.2%) suffered transitory renal dysfunction, but only one patient (5.6%) required hemodialysis. Median follow-up time was 17 months (range: 2-29 months) and there was just one late death, from ischemic heart disease, 7 months after the surgery on the abdominal aorta. Conclusions: Aortic reconstruction is a safe method for treating patients with CAIO, with low perioperative morbidity and mortality rates.

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“…While conventional surgery is effective and durable, 15 it is associated with greater invasivity and considerable morbidity and mortality, particularly among patients at high operative risk. Continuous development of materials by the industry has allowed endovascular treatment to become established as an important alternative operating technique for AAA, particularly for patients with favorable anatomy.…”

Section: Discussionmentioning

confidence: 99%

Endovascular repair of a juxtarenal saccular aneurysm using the Multilayer Flow Modulator: report of the first case performed in a Public Hospital in Brazil

et al. 2014

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Endovascular treatment of abdominal aortic aneurysms (AAA), involving the exits of the renal and visceral arteries still constitutes a considerable challenge. Many different techniques have been developed over the years in attempts to surmount the difficulties presented by these cases. Techniques that have gained prominence include fenestrated or branched stents, methods involving parallel prostheses, such as the chimney, periscope and sandwich techniques, and, more recently, flow modulation with Multilayer stents. We describe a case of a complex juxtarenal saccular AAA with a high surgical risk, both according to cardiological assessment and because the patient had a difficult airway caused by a total laryngectomy for early stage laryngeal neoplasm. In view of the technical simplicity of using Multilayer stents, the presence of chronic obstructive aortoiliac disease, ostial stenosis of the renal artery and a small diameter suprarenal aorta, options involving fenestrated/branched stents and techniques involving parallel prostheses were ruled out, because of the need for multiple accesses. In view of the dilemma it presented, we describe this case as a therapeutic challenge and present the treatment option employed, which has been successful over the short term.Keywords: aorta; aneurysm aortic; endovascular procedures. ResumoO tratamento endovascular de aneurismas de aorta abdominal (AAA), envolvendo a saída das artérias renais e viscerais, constitui ainda um importante desafio. Diversas técnicas foram desenvolvidas ao longo do tempo para contornar as dificuldades oferecidas por esta situação, destacando-se as endopróteses fenestradas ou ramificadas, as técnicas envolvendo próteses paralelas, como Chaminé, Periscópio e Sanduíche, e, mais recentemente, a utilização da modulação de fluxo por stent multicamadas Multilayer. Apresentamos um caso de AAA sacular complexo justarrenal e com alto risco cirúrgico pela avaliação cardiológica e por apresentar via aérea difícil, em decorrência de laringectomia total por antecedente de neoplasia de laringe. Devido à facilidade técnica do uso do Multilayer, à presença de doença obstrutiva crônica aorto-ilíaca, à estenose ostial renal e ao diâmetro limitado da aorta suprarrenal, descartaram-se as opções envolvendo endopróteses fenestradas/ramificadas ou técnicas envolvendo próteses paralelas, pela necessidade de diversos acessos para a execução. Diante do dilema imposto, apresentamos este caso como desafio terapêutico e com uma opção de tratamento bem sucedida, em curto prazo.Palavras-chave: aorta; aneurisma aórtico; procedimentos endovasculares.

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Open repair of juxtarenal aortic aneurysms (JAA) remains a safe option in the era of fenestrated endografts

Cited by 151 publications

References 27 publications

Effect of Suprarenal Aortic Cross-Clamping

Effect of Suprarenal Aortic Cross-Clamping

Surgical treatment of chronic aortoiliac occlusion

Endovascular repair of a juxtarenal saccular aneurysm using the Multilayer Flow Modulator: report of the first case performed in a Public Hospital in Brazil

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