[Open repair of pararenal aortic aneurysms]

Surgical treatment of pararenal aortic aneurysms, if compared to open repair of infrarenal aneurysms, is characterized by more technical difficulties and haemodynamic problems. Since endovascular repair has become feasible in most cases of infrarenal aneurysms, surgical treatment of pararenal aneurysms is a matter of great interest for vascular surgery. Detection of pararenal aneurysms needs a careful preoperative diagnosis, assessment of cardiac, renal and pulmonary status of the patient and planning of the surgical intervention. The surgeon needs to face an extended proximal aorta exposure, to manage the left renal vein and to choose an appropriate clamping site. Then a skilled and quick reconstruction of the visceral arteries is fundamental to minimize organ disfunction. Coupled intraoperative selective perfusion of visceral arteries and systemic administration of nephroprotective drugs optimizes organ protection during ischemia. To better define challenges, risks and results, we reviewed our experience with the treatment of pararenal aortic aneurysms. In the period between January 1993 and May 2003, 98 consecutive patients underwent surgery for pararenal aneurysms at our Institution. We treated 98 pararenal aneurysms, divided in 68 juxtarenal and 30 pararenal ones. In the juxtarenal aneurysms group, the 30 days mortality rate was 5.8% (4/68); 3 of these patients underwent urgent operation for ruptured aneurysm. In the suprarenal aneurysms group, the 30 days mortality rate was 3.3% (1/30). In conclusion pararenal aneurysm repair is a safe procedure, especially if performed electively, and represents an interesting field of research to improve surgical and anesthesiologic techniques.