Pararenal aortic aneurysms: The future of open aortic aneurysm repair

Jean-Claude, Jessie; Reilly, Linda M.; Stoney, Ronald J.; Messina, Louis M.

doi:10.1016/s0741-5214(99)70218-1

Cited by 132 publications

(118 citation statements)

References 16 publications

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“…As a consequence, mortality rate and renal failure rate are the major concerns with regard to the safety of the procedure [13]. The in-house mortality rate for this study was 3% of non-ruptured elective infrarenal aneurysms, which was in agreement with the pooled data published in several referral-based studies [7].…”

Section: Discussionsupporting

confidence: 88%

“…Since the introduction of endovascular aortic repair in 1991 [15], up to 70% of infrarenal aneurysms are currently estimated to be candidates for stent-graft implantation [5,19]. As a result, the percentage of aneurysms of the perirenal region for open repair is growing [13,17]. This is mainly due to the [2,10,11].…”

Section: Discussionmentioning

confidence: 99%

“…The study of Green et al [9] established that supravisceral clamping is safer than suprarenal clamping, due to the avoidance of embolization of atherosclerotic debris from the perirenal region. The San Francisco Group [13] and the Cleveland Clinic [17] already mentioned the methodological errors of Green's analysis on patients in whom complications developed due to failed infrarenal cross-clamping [9]. Data by Sarac [17] reported no significant difference in the mortality seen between suprarenally and infrarenally clamped aneurysms (2.1 vs 2.8%).…”

Section: Discussionmentioning

confidence: 99%

“…The number of juxtarenal aneurysms (JRA) evaluated for subsequent open aortic repair has increased frequently since the introduction of endovascular aortic treatment in 1991 [13,15,17]. In comparison to infrarenal aortic aneurysms (AAA), the operative strategy for JRA is characterized by the need for suprarenal cross clamping with potentially higher morbidity and mortality rates and the risk of impairment of renal function.…”

Section: Introductionmentioning

confidence: 99%

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Comparative early and midterm results of open juxtarenal and infrarenal aneurysm repair

Ockert

Schumacher

Böckler

et al. 2007

Langenbecks Arch Surg

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparative early and midterm results of open juxtarenal and infrarenal aneurysm repair

Ockert

Schumacher

Böckler

et al. 2007

Langenbecks Arch Surg

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show abstract

“…Open surgery in short-neck/juxtarenal aneurysms is not extensively described in the literature, but several reports do specify the greater risks of mortality and morbidity. [26][27][28] Mortality rates vary between 5.8 and 9%. Renal function deterioration is not infrequent and has been reported in up to 40.5% of the cases, with 7.0% of patients requiring dialysis.…”

Section: Fenestrated and Branched Evarmentioning

confidence: 99%

Open Treatment Versus Endovascular Repair for Aortic Abdominal Aneurysm-Keeping the Balance

Bos¹,

Cohen²,

Vourliotakis³

et al. 2009

Annals of Vascular Diseases

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E ndovascular repair of abdominal aortic aneurysms (EVAR) has enjoyed a quick and widespread growth over the last 15 years. Both clinicians and patients have embraced the minimal invasive alternative to open surgery. Although early benefits of EVAR have been confirmed in two randomized trials, the number of late complications and re-interventions remains an issue for debate.1, 2) However, the trials failed to demonstrate a late overall survival gain. This opened the way for some epidemiologists and other financial decision makers to question the technique or even worse, to qualify the technique as a failed experiment.3) Despite this, this important surgical innovation has continued to evolve with expansion into the treatment of acute aneurysms and the development of fenestrated and branched grafts. This paper discusses the ongoing evolution of EVAR with respect to the available literature and our personal experience. Elective EvarAs mentioned, the short-term benefits have undoubtedly been demonstrated by two randomized trials. In summary, EVAR presents with a threefold lower mortality than open repair (P = 0.009, EVAR trial) and almost a twofold lower aneurysm related mortality at four years (4% versus 7%, P = 0.04 EVAR trial). In addition, the health related quality of life, often regarded as non-different due to similar results after one year, demonstrated a better outcome from 3 to 12 months.2) Costs were higher in the trial setting, but the difference was marginal, and there are no post-trial comparisons available. The flip side was that the two randomized trials demonstrated a higher late complication rate which resulted in a higher reintervention rate of EVAR compared to open repair.Since the trials, the technique has matured and devices have undergone further development. This has widely resulted in better results especially with regard to durability and reintervention rate. Many reports were published on these changes in outcome with maturation of the technique with the lifeline Registry and Eurostar Registry reporting a decrease in secondary interventions over time. 4,5) With increased experience it is also became clear that Type II endoleaks were not presenting with increased risk of rupture as initially thought. Silverberg et al. reported an incidence of Type II endoleaks of 16% (154/ 946), but 35% of these Type II endoleaks resolved spontaneously during a mean follow-up of 14.5 months.6) A Kaplan Meier analysis suggested spontaneous seal of Type II endoleak of 75% within 5 years. Franks et al. reported in a systematic review a decreasing trend over time in operative mortality, endoleak rate and post-operative rupture. 7)Our personal results show a mortality below 1% which includes all patients, both low-and high risk, and difficult anatomy. The overall reintervention rate dropped from 15% to below 10% with 75% of all reinterventions performed by endovascular means. Furthermore reinterventions were not associated with mortality.

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Open Abdominal Aortic Aneurysm Repair in the Endovascular Era

Landry¹

2009

Arch Surg

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Until fenestrated and branched endografts are available, open AAA repairs will become increasingly complex. Suprarenal cross-clamping is associated with increased rates of complications but similar mortality rates and need for nursing home placement. With the disappearance of straightforward open aneurysm repair, trainees in vascular surgery will have to learn AAA repair almost exclusively by operating on patients with complex AAAs. Fewer surgeons will perform these repairs, and fewer fellows will be able to complete the operation independently immediately after training.

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Pararenal aortic aneurysms: The future of open aortic aneurysm repair

Cited by 132 publications

References 16 publications

Comparative early and midterm results of open juxtarenal and infrarenal aneurysm repair

Comparative early and midterm results of open juxtarenal and infrarenal aneurysm repair

Open Treatment Versus Endovascular Repair for Aortic Abdominal Aneurysm-Keeping the Balance

Open Abdominal Aortic Aneurysm Repair in the Endovascular Era

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