Outcomes of Open Repair, Fenestrated Stent Grafting, and Chimney Grafting in Juxtarenal Abdominal Aortic Aneurysm: Is It Time for a Randomized Trial?

Chinsakchai, Khamin; Prapassaro, Tossapol; Salisatkorn, Worawong; Hongku, Kiattisak; Moll, Frans L.; Ruangsetakit, Chanean; Wongwanit, Chumpol; Puangpunngam, Nattawut; Hahtapornsawan, Suteekhanit; Sermsathanasawadi, Nuttawut; Mutirangura, Pramook

doi:10.1016/j.avsg.2018.08.097

Cited by 22 publications

(22 citation statements)

References 18 publications

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“…In our cohort of 214 patients, we observed in-hospital mortality rate of 1.9%, which is consistent with the published results in other centres at 1.2–5.2% [ 2 , 17 , 18 , 19 , 20 , 21 ]. The most common mortality cause in our series was a major cardiac event due to coronary artery disease.…”

Section: Discussionsupporting

confidence: 92%

“…Interestingly, the severity of the respiratory insufficiency was related to the invasiveness of the operation. This correlation was already observed and discussed from other authors [ 18 , 19 ]. Surprisingly, despite the 37.3% ( n = 80) suprarenal clamping, acute renal failure occurred in only 2.3% ( n = 5) of our patients, which is a relatively low rate according to the literature [ 18 , 19 ].…”

Section: Discussionsupporting

confidence: 87%

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Open Treatment of Abdominal Aortic Aneurysm in the Endovascular Era

Ibrahim

Yordanov

Hasso

et al. 2022

JCM

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The aim of the study was to analyse outcomes and determine the early and late complications in patients after open surgical treatment of AAA in the endovascular era. Two hundred and fourteen patients between January 2012 and December 2021 with open repair in primary infrarenal and juxtarena aneurysm in elective setting were included in the study. Pre-, intra-, and postoperative clinical data were statistically analysed. The mean age of the 214 patients was 65.5 ± 9.3 years. The mean follow-up was 22.1 ± 2.1 months. Men represented the majority of the studied group (85.5%). The mean aortic diameter was 58.2 ± 13.4. The median ICU (days) stay was 5 ± 4.9 days for infrarenal aneurysm and 6 ± 6.1 days for juxtarenal aneurysm. Four patients died within 30 days, giving an in-hospital mortality rate of 1.9%. In multivariate logistic regression, COPD (p = 0.015) was the only predictor significantly associated with the mortality. A comparison of survival and reintervention using a Kaplan–Meier curve showed no significant difference between the groups in terms of risk stratification and the groups with juxtarenal versus infrarenal aneurysms. In conclusion, open aneurysm repair is in the era of endovascular aneurysm repair, being safe and effective, especially when performed in specialised high-volume centres with large expertise.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 87%

Open Treatment of Abdominal Aortic Aneurysm in the Endovascular Era

Ibrahim

Yordanov

Hasso

et al. 2022

JCM

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“…Although many have indicated significant potential advantages of endovascular procedures as a reason to avoid open surgery to treat complex AAAs, the true benchmark for open surgery still remains unclear. [26][27][28] However, dialysis requirement and mortality for open reconstruction seemed similar to those reported for complex endovascular repairs. [29,30] Indeed, we believe that unsuccessful endovascular procedures tend to increase the complexity of open surgery and, hence, the negative consequences, due to the disproportionate increase in the frequency of use and experience.…”

Section: Survival Function Censoredsupporting

confidence: 60%

Open repair of juxtarenal aortic aneurysms: 10-years of experience in a single center

Kahraman¹

2020

Turk J Vasc Surg

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Objectives: This study aims to evaluate the long-term surgical outcomes of juxtarenal aortic aneurysms (JAAs). Patients and methods: We retrospectively analyzed a total of 21 consecutive patients (20 males, 1 female; mean age 64.8±11.8 years; range, 31 to 80 years) who underwent open repair of JAAs using a suprarenal clamp between May 2009 and May 2019. Data including baseline demographic and clinical characteristics of the patients, preoperative risk factors, radiographic images, and postoperative data were recorded. Results: Of all patients, six had a failed endograft. The median time to the completion of surgery was 286 (range, 192 to 628) min and the median renal ischemia time was 42 (range, 20 to 82) min. Renal artery endarterectomy (n=5), reimplantation (n=2), and an extension graft interposition (n=2) were the additional procedures to ensure kidney perfusion. During a follow-up of 48 months, six patients required dialysis and three were permanent, and the overall mortality rate was 33.3%. Conclusion: The results of JAA repair become steadily worsened due to the changes in the rate and severity of constitutional risk factors during the last decade. The increasing number of failed endovascular procedures increases the need for a suprarenal clamp. Therefore, failed endograft should be considered an etiological factor and a risk factor for the open repair of JAAs currently.

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“…We included 15 studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] 25 was included as the 15th study because it contains 2-year follow-up data from the 2015 study by Michel et al 24 Of the 20 studies that had met the inclusion criteria, five had contained duplicate data presented in other studies and, therefore, were excluded from the present meta-analysis. [31][32][33][34][35] No randomized controlled trials had evaluated the outcomes of endovascular vs open repair for JRAs.…”

Section: Resultsmentioning

confidence: 99%