Operative treatment of juxtarenal aortic atherosclerosis

Symptomatic juxtarenal aortic atherosclerosis is a rare and threatening form of aortic disease. The formidable implications of complex aortic reconstruction, the high operative mortality and morbidity rate and the uncertainties regarding the beneficial effects of operation combined to foster highly conservative attitude regarding management. Our reported experience and a brief review which has been highlighted in this report, support an aggressive use of combined aortic and renal branch repair rather than a staged repair or medical management. Operative mortality was higher only in the patients with the most extensive patterns of atherosclerosis. This should caution careful preoperative assessment in order to plan optimum technique and extent of the reconstruction for these higher risk patients. The renal revascularization had a significant beneficial effect on hypertension and excretory function observed both early and late following operation. Furthermore a lower than expected late mortality supports our contention that combined aortic and renal reconstruction increases survival of the patients by preventing the complications of progressive renal ischemia, accelerated hypertension, and renal failure.