Koji Maeda1, Takao Ohki2, Yuji Kanaoka2, Takeshi Baba2, Kenjirou Kaneko2, Kota Shukuzawa2. 1. Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan. Electronic address: koji-m@jikei.ac.jp. 2. Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: To evaluate the optimal treatment for juxtarenal abdominal aortic aneurysm (JAAA), we compared the outcomes of open surgical repair (OSR) with endovascular aortic repair (EVAR) using a variety of fenestrated and snorkel EVARs. METHODS: We evaluated overall survival, aneurysm-related death, reintervention, and renal impairment in 152 JAAAs retrospectively, excluding cases of aortic dissection and rupture. Cox models were used to assess survival and assessed postoperative dialysis rates following surgery. RESULTS: OSR and EVAR were performed in 81 and 71 patients, respectively. The mean age was significantly higher in the EVAR group (overall, 74.5 years; OSR, 71 years; and EVAR; 77 years). High preoperative serum creatinine levels, cerebrovascular disease, and chronic obstructive pulmonary disease were more prevalent in the EVAR group. Mean operative time, hospital stay, and perioperative blood loss were significantly greater in the OSR group (P < 0.001 for all). The overall 30-day mortality was 1.9% with no statistical difference between 2 groups. The reintervention rate was significantly higher in the EVAR group (P = 0.01). Overall survival rates at 1, 3, 5, and 7 years were 97.4%, 91.6%, 86.3%, and 82.9%, respectively, with no significant difference between groups. Mortality in EVAR was associated with over 3.0 mg/dL of postoperative creatinine, and postoperative dialysis following OSR was associated with operative time and volume of bleeding. CONCLUSIONS: Acceptable outcomes were observed with OSR and EVAR. However, reintervention was more frequently required following EVAR. OSR appears to be the most appropriate first-line treatment for JAAA in good-risk patients; however, EVAR may represent an alternative option in high-risk patients.
BACKGROUND: To evaluate the optimal treatment for juxtarenal abdominal aortic aneurysm (JAAA), we compared the outcomes of open surgical repair (OSR) with endovascular aortic repair (EVAR) using a variety of fenestrated and snorkel EVARs. METHODS: We evaluated overall survival, aneurysm-related death, reintervention, and renal impairment in 152 JAAAs retrospectively, excluding cases of aortic dissection and rupture. Cox models were used to assess survival and assessed postoperative dialysis rates following surgery. RESULTS: OSR and EVAR were performed in 81 and 71 patients, respectively. The mean age was significantly higher in the EVAR group (overall, 74.5 years; OSR, 71 years; and EVAR; 77 years). High preoperative serum creatinine levels, cerebrovascular disease, and chronic obstructive pulmonary disease were more prevalent in the EVAR group. Mean operative time, hospital stay, and perioperative blood loss were significantly greater in the OSR group (P < 0.001 for all). The overall 30-day mortality was 1.9% with no statistical difference between 2 groups. The reintervention rate was significantly higher in the EVAR group (P = 0.01). Overall survival rates at 1, 3, 5, and 7 years were 97.4%, 91.6%, 86.3%, and 82.9%, respectively, with no significant difference between groups. Mortality in EVAR was associated with over 3.0 mg/dL of postoperative creatinine, and postoperative dialysis following OSR was associated with operative time and volume of bleeding. CONCLUSIONS: Acceptable outcomes were observed with OSR and EVAR. However, reintervention was more frequently required following EVAR. OSR appears to be the most appropriate first-line treatment for JAAA in good-risk patients; however, EVAR may represent an alternative option in high-risk patients.