Perioperative Outcomes of Complex Abdominal Aortic Aneurysms

Objectives: Complex abdominal aortic aneurysms (c-AAAs) are defined by the absence of an infrarenal clampable aortic segment during open repair or a suitable neck for standard endovascular aneurysm repair. These anatomically challenging lesions necessitate advanced surgical strategies. This study evaluates the 30-day perioperative outcomes following open surgical repair of c-AAAs and explores the clinical and intraoperative variables influencing postoperative morbidity and mortality. Materials and Methods: A retrospective review was conducted on 61 patients who underwent open c-AAA repair at our institution between January 2019 and June 2025. Aneurysm types included juxtarenal ( n = 39), pararenal ( n = 11), paravisceral ( n = 1), and type IV thoracoabdominal aneurysms ( n = 10). The primary outcome was 30-day all-cause mortality. Secondary outcomes included acute kidney injury (AKI) as per RIFLE criteria, pulmonary and cardiac complications, and target vessel occlusion rates. Statistical methods included descriptive analysis, Chi-square and t -tests, correlation analysis, and multivariate regression with significance defined at P < 0.05. Results: The cohort had a mean age of 65.3 ± 10.7 years, predominantly male (86.9%), with hypertension noted in 93%. Overall perioperative mortality was 9.8% ( n = 6). Independent factors significantly associated with mortality included diabetes mellitus (χ 2 = 5.483; P = 0.019) and concomitant visceral procedures (χ 2 = 4.143; P = 0.042). AKI occurred in 44.3% ( n = 27), although only one patient required long-term hemodialysis; renal function normalized at discharge in the remainder. Ligation of the left renal vein significantly increased AKI incidence (71.4% vs. 36.2%; P = 0.02). Elevated preoperative serum creatinine (chronic kidney disease [CKD] stage >3) and greater aneurysmal complexity were associated with worsened postoperative renal function ( P = 0.001 and P = 0.036, respectively). Conclusions: Open repair of c-AAAs remains technically demanding, necessitating suprarenal clamping that transiently impairs renal function. However, most patients recover without dialysis. Preexisting diabetes and CKD increase postoperative risk, underscoring the importance of meticulous preoperative optimization and individualized surgical planning.