1. Is Mini-Invasive Surgery an Alternative for the Treatment of Juxtarenal Aortic Aneurysms?
- Author
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Michele Aronici, Carla Porta, Alberto M. Settembrini, Massimiliano Martelli, Alessandra Renghi, Francesco Casella, Letizia De Simeis, Eugenio Martelli, Piero Brustia, and Giovanni Coppi
- Subjects
kidney ,medicine.medical_specialty ,constriction ,Renal function ,time factors ,Group B ,Mini invasive surgery ,Aortic aneurysm ,chemistry.chemical_compound ,fast track surgery ,aortic aneurysm ,mini-laparotomy ,supra renal cross clamping ,aged ,aortic aneurysm, abdominal ,enhanced recovery after surgery ,female ,humans ,kidney diseases ,length of stay ,male ,operative time ,retrospective studies ,risk assessment ,risk factors ,treatment outcome ,blood vessel prosthesis implantation ,medicine ,Rifle ,Creatinine ,business.industry ,Mortality rate ,General Medicine ,medicine.disease ,Surgery ,Clamp ,chemistry ,abdominal ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal - Abstract
Introduction Aim of our study is to evaluate the outcomes of mini-laparotomy, suprarenal cross-clamping, and enhanced recovery after elective open surgical repair for juxta-renal abdominal aortic aneurysms (JAAA) in a tertiary referral center. Methods Data of all consecutive patients with abdominal aortic aneurysms (AAA) electively treated with left sub-costal mini-laparotomy requiring infrarenal or suprarenal cross-clamping between 2013 and 2018 were retrospectively collected. Patients were divided into two groups: infra-renal cross-clamping (group A) and JAAA requiring supra-renal cross-clamping (group B). Early and mid-term mortality, postoperative renal dysfunction according to RIFLE criteria and factors affecting postoperative outcome were analysed. Results Four hundred one patients, 356 (88.8%) men, mean age 70.8 yrs, underwent open surgical repair (OSR), 343 (85.5%) AAA in group A, 58 (14.5%) JAAA in group B. Mean diameter of the aneurysms was 54 ± 11.4 mm vs. 52 ± 9 mm and mean time of intervention 154.9 ± 56.3 min vs. 180.1 ± 65.7 min respectively. Total clamp time was 72.27 ± 31.4 vs. 75 ± 33.1 and suprarenal clamp time in group B 27.82 ± 14.1 min. Mean hospital length of stay was 5.1 ± 2.8 vs. 5.37 ± 3.4 days respectively. At 30 days, 3 (0.9%) patients died in group A and no one in group B; at 24 months 7 (2%) deaths in group A and 4 (6.9%) in group B. Preoperative, postoperative and discharge serum creatinine mean value, in group B, were 1.07 ± 0.32, 1.31 ± 0.36 and 1.83 ± 1.24 respectively. Based on RIFLE criteria for renal function, we observed Risk in 14.2% and Injury in 12.7% of patients after suprarenal cross clamping. Conclusions Our results show that mini-invasive open repair for JAAA with a suprarenal cross-clamping can be performed with acceptable morbidity and mortality rates similar to traditional surgical approach without significant modifications of renal functions.
- Published
- 2022