The Juxtarenal Abdominal Aortic Aneurysm

OBJECTIVE: To determine the incidence and treatment outcome of juxtarenal infrarenal aneurysmectomy in a vascular practice minimally biased by tertiary referral. DESIGN: A 5-year retrospective review of all aortic operations from our vascular registry was performed, and a case series of juxtarenal aneurysmectomies was analyzed. PATIENTS: Of 174 infrarenal aortic aneurysmectomies performed, 27 (15.5%) (95% confidence interval, 10.5% to 21.8%) involved the juxtarenal aorta. INTERVENTIONS: Juxtarenal involvement was unsuspected but found by aortography in 25 (93%) of 27 cases. Resection was performed transabdominally in 20 cases (74%) and retroperitoneally in seven cases (26%). MAIN OUTCOME MEASURES: Incidence, operative technique, morbidity, and mortality were analyzed and compared with those of historical controls. RESULTS: The incidence of juxtarenal aneurysmectomy was 15.5%. No operative deaths occurred, but there was a 19% incidence of surgical morbidity (including a 7% incidence of transient renal failure). The late survival rate was 89% (follow-up, 1 to 53 months; mean, 18 months). CONCLUSIONS: Juxtarenal aortic aneurysms are not uncommon. Successful management is possible, even outside the large referral center.