Juxtarenal aortic atherosclerosis. Surgical experience and functional result

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Surgical Outcomes

Background:

• Severe symptomatic aortic occlusive disease, aortic aneurysmal disease, and visceral atherosclerosis pose significant clinical challenges.
• Combined aortic and renal artery reconstructions are complex procedures with potential for substantial morbidity and mortality.

Purpose of the Study:

• To evaluate the outcomes of combined aortic and renal artery reconstruction in patients with severe symptomatic atherosclerotic disease.
• To assess the impact of this combined surgical approach on hypertension and renal function.
• To determine the perioperative and long-term mortality and morbidity associated with these complex reconstructions.

Main Methods:

• Ninety patients underwent combined aortic and renal artery reconstruction for various atherosclerotic conditions.
• Procedures included transaortic endarterectomy and prosthetic grafting, with standard transabdominal or thoraco-retroperitoneal approaches.
• Patients were evaluated for perioperative outcomes, hypertension control, renal function, and long-term survival.

Main Results:

• Perioperative mortality was 9% and morbidity was 16%.
• Hypertension was cured or improved in 82% at discharge, sustained in 96% long-term.
• Renal function improved or was preserved in 93% at discharge, sustained in 84% long-term.
• Late mortality was 11%, attributed to the combined repair technique and management of comorbidities.

Conclusions:

• Combined aortic and renal artery reconstruction is an effective treatment for severe symptomatic atherosclerotic disease.
• The technique offers significant benefits in hypertension control and renal function preservation.
• This approach is associated with favorable long-term outcomes and reduced late mortality.