Retrospective Cohort Study: Supraceliac Cross Clamping Does Not Affect Early Outcomes After Juxtarenal Aneurysm...

Supraceliac clamping may be required during repair of short-neck or juxtarenal abdominal aortic aneurysms (AAAs). Its use remains controversial, mainly due to potential renal risks. This study reports the outcomes of its routine use in the surgical management of these complex aneurysms.

Between January 2008 and December 2024, 207 patients underwent open repair of short-neck or juxtarenal AAAs. Data were retrospectively analyzed, including demographic variables, aneurysm characteristics, intraoperative details, and early morbidity and mortality outcomes. The primary end point was postoperative acute kidney injury (AKI) according to the Risk, Injury, Failure, Loss, End-stage kidney disease classification. Secondary end points included early morbidity and mortality, as well as overall survival at 1 and 5 years.

During the study period, 114 patients required an infrarenal clamp and 93 a supraceliac clamp. The median age was 67 years. Early morbidity and mortality outcomes were compared between the infrarenal and supraceliac clamping groups. No increased risk of postoperative AKI was observed (23% vs. 32%, P = 0.22). The 30-day mortality rate was 2% and did not differ according to clamp level. In multivariate analysis, preexisting chronic kidney disease, greater blood loss, and the presence of atheroma in the proximal neck were independently associated with postoperative AKI (odds ratio 7.0, P = 0.01).

Routine use of supraceliac clamping for the repair of short-neck or juxtarenal AAAs appears to be an efficient and rapid technique, without increasing short-term morbidity or mortality, particularly regarding renal outcomes.