BACKGROUND: We report our 11-year experience of juxtarenal aortic aneurysm (JAA) repair with suprarenal aortic cross-clamping. METHODS: We retrospectively reviewed 51 consecutive JAA repairs performed between 2000 and 2010. In all 51 patients, aneurysms were replaced by prosthetic grafts with simple suprarenal aortic cross-clamping. No special renal protective measures (except inter-renal cross-clamping) were performed during interruption of perfusion to kidneys. For inter-renal cross-clamping, the aortic cross-clamp was placed from below one renal artery to above the other renal artery to maintain hemilateral renal perfusion. This technique was applied in 27 patients (54%). Postoperative complications, renal function, and survival were evaluated. RESULTS: There were no deaths. The average renal ischemia time was 28.9 ± 9.7 minutes. Postoperatively, transient renal failure (defined as an estimated glomerular filtration rate of <30 mL/min/1.73 m(2)) occurred in 14% of the patients. The postoperative decrease of estimated glomerular filtration rate compared with the preoperative value was significantly smaller in the inter-renal clamp group (7.4% ± 16%) than in the suprarenal clamp group (17.5% ± 16%) (P < 0.05, unpaired t test). However, renal dysfunction was temporary and recovered to baseline before discharge with conservative therapy in all patients except one. In addition, renal function was generally preserved at 1 year after surgery. CONCLUSION: Surgical repair of JAA can be performed with simple cross-clamping and an acceptable renal ischemic time, achieving excellent results. Inter-renal cross-clamping reduces renal damage compared with suprarenal cross-clamping.
BACKGROUND: We report our 11-year experience of juxtarenal aortic aneurysm (JAA) repair with suprarenal aortic cross-clamping. METHODS: We retrospectively reviewed 51 consecutive JAA repairs performed between 2000 and 2010. In all 51 patients, aneurysms were replaced by prosthetic grafts with simple suprarenal aortic cross-clamping. No special renal protective measures (except inter-renal cross-clamping) were performed during interruption of perfusion to kidneys. For inter-renal cross-clamping, the aortic cross-clamp was placed from below one renal artery to above the other renal artery to maintain hemilateral renal perfusion. This technique was applied in 27 patients (54%). Postoperative complications, renal function, and survival were evaluated. RESULTS: There were no deaths. The average renal ischemia time was 28.9 ± 9.7 minutes. Postoperatively, transient renal failure (defined as an estimated glomerular filtration rate of <30 mL/min/1.73 m(2)) occurred in 14% of the patients. The postoperative decrease of estimated glomerular filtration rate compared with the preoperative value was significantly smaller in the inter-renal clamp group (7.4% ± 16%) than in the suprarenal clamp group (17.5% ± 16%) (P < 0.05, unpaired t test). However, renal dysfunction was temporary and recovered to baseline before discharge with conservative therapy in all patients except one. In addition, renal function was generally preserved at 1 year after surgery. CONCLUSION: Surgical repair of JAA can be performed with simple cross-clamping and an acceptable renal ischemic time, achieving excellent results. Inter-renal cross-clamping reduces renal damage compared with suprarenal cross-clamping.
Authors: Xiaojie Wang; Jialing Liu; Wenqing Yin; Farhiya Abdi; Paul D Pang; Quynh-Anh Fucci; Molly Abbott; Steven L Chang; Graeme Steele; Ankit Patel; Yutaro Mori; Aifeng Zhang; Shikai Zhu; Tzong-Shi Lu; Adam S Kibel; Bin Wang; Kenneth Lim; Andrew M Siedlecki Journal: Am J Pathol Date: 2020-01-20 Impact factor: 4.307