Experiences of Surgical Treatment for Juxtarenal Aortic Occlusion

PURPOSE To evaluate the outcomes of juxtarenal aortic occlusion (JRAO), a review of 15 patients who underwent aortic bypass replacement following aortorenal thrombectomy, especially focusing on the safety of suprarenal aortic clamping or transient aortic compression, was undertaken. MATERIALS AND METHODS During the period of June 2001 to November 2012, 15 patients with JRAO (chronic 10, acute 5) were analyzed retrospectively. JRAO with combined stenosis of the renal artery was found in 2 patients, renal artery thrombus in 8 patients, and normal in 5 patients. RESULTS All patients were males. Mean age was 61.7±11.2 years. There were 14 aortobifemoral bypass grafting and 1 aortobiiliac bypass grafting. Six Dacron and 9 PTFE artificial Y-grafts were implanted to the aorta with end-to-end anastomosis in the proximal aorta. Suprarenal aortic clamping was performed in 7 patients, supraceliac clamping in 2 patients, and transient aortic compression in 6 patients. There were 13 cases with aortic clamping time <10 minutes and 2 cases with >10 minutes. Thrombectomy of the aorta and renal artery was performed in 10 (66.7%) patients. There were no operative mortality cases. The perioperative morbidity rate was 26.7% (4/15). Preoperative renal function was impaired in four patients. The renal functions of these cases were recovered postoperatively. CONCLUSION Aortic bypass replacement following aortorenal thrombectomy with suprarenal aortic clamping or transient aortic compression for JRAO is the optimal treatment. It is important to focus on short renal ischemic time during suprarenal aortic clamping for prevention of renal damage. It provides unmatched perioperative and long-term results.