Mayo Reviews Pararenal AAA Open Surgery

Timothy F. Kirn

Open surgical repair of pararenal abdominal aneurysms can be performed with a 30-day mortality rate of only 2.5%, according to a patient series from the Mayo Clinic.

Between 1993 and 2003, a total of 3,058 open surgical repairs of abdominal aortic aneurysms (AAAs) were performed. Of those, 247 were pararenal AAAs, reported Charles A. West, M.D., of the Mayo Clinic, Rochester, Minn.

The most common complication was postoperative renal insufficiency, which occurred in 22% of the patients and was associated with increased mesenteric ischemia time, left renal vein division, and renal artery bypass.

The mean renal ischemia time was 23 minutes, according to Audra A. Noel, M.D., who was the senior author of the paper presented by Dr. West, who first reported the information at this year's Midwestern Vascular Surgery Society annual meeting, in Chicago.

Pulmonary complications occurred in 16% of patients and were associated with advanced age, suprarenal aneurysm repair, increased mesenteric ischemia time, renal artery bypass, and left renal vein division.

The investigators were unable to identify any specific factors associated with the six deaths that occurred within 30 days of the procedures.

The purpose of their review of the cases treated at the Mayo was to provide a baseline comparison that could be used now that so many AAA repairs are being done through an endovascular procedure. In the future, it will probably be possible to fix pararenal aortic aneurysms with endovascular branch-graft repairs.