PC18. Long-Term Outcomes Following Open Juxtarenal Abdominal Aortic Aneurysm Repair: Degeneration of Remnant Aorta and Need for Reintervention

Abstract

The fate of remnant aneurysmal or ectatic aortic segments and the need for reintervention following open juxtarenal abdominal aortic aneurysm (JRAA) repair remains undefined. The aim of this study was to assess long-term outcomes of open JRAA repair with emphasis on morphological changes of remnant proximal aortic tissue to facilitate selection of patients who would benefit from initial fenestrated endovascular repair (FEVAR). Data from consecutive patients who underwent elective open JRAA repair from January 2001 to August 2010 were retrospectively analyzed. Demographics, preoperative risk factors, reintervention, and mortality were evaluated. Aortic diameter changes were evaluated in patients with available postoperative computed tomography (CT) scans. Outer aortic diameter measurements were performed at four levels: renal (RA), suprarenal (SRA), supramesenteric (SMA) and supraceliac (CA). There were 161 patients (125 men, 36 women) with a mean age of 73.5 years (range, 55-93 years). Risk factors included coronary artery disease in 61%, renal insufficiency (serum creatinine >1.5 mg/dL) in 30%, and pulmonary disease in 56%. Mean Society for Vascular Surgery risk score was 9.2 ± 4.7. The proximal anastomosis was sewn to normal aorta (< 30 mm) in 79 patients and to ectatic aorta (≥30 mm) in 72 patients. Thirty-day mortality was 0. Median clinical follow-up was 7.2 years (range, 4 days-14 years). Seventy patients died during follow-up, and one aortic reintervention was performed. On Kaplan-Meier analysis, survival free of reintervention in the entire cohort at 1, 3, and 5 years was 96%, 92%, and 92%; overall survival was 89%, 79%, and 28% at 3, 5, and 10 years (Fig). Seventy patients had postoperative CT scans. On imaging follow-up at a mean of 30 months, average aortic growth was 0.6 ± 1.6 mm at RA, 1.3 ± 2.1 mm at SRA, 1.4 ± 1.8 mm at SMA, and 1.5 ± 2.7 mm at CA. No significant difference in growth was found in patients with anastomoses sewn to remnant normal vs ectatic aorta (0.2 ± 1.9 mm vs 0.3 ± 0.9 mm, P = .1). Growth of remnant paravisceral aortic segments following open JRAA repair is slow, and only a minority of patients require reintervention during their lifetime. Based on these results, patients should be selected for initial FEVAR based on medical comorbidities and not ectasia of the paravisceral aorta. Open JRAA repair remains a durable procedure.