Endovascular technologies continue to evolve for the treatment of complex aortic aneurysms. This results in less experience with open repair of juxtarenal and pararenal abdominal aortic aneurysms (PAAA) and repairs occurring in patients with prior endovascular interventions. We sought to determine contemporary patient characteristics and early outcomes for open repair of PAAA. Data from consecutive patients undergoing PAAA repair requiring aortic clamping above at least one main renal artery between 2001 and 2014 were retrospectively reviewed. The patient cohort was divided into two chronological groups, before and after maturation of a fenestrated endograft repair program at our institution: group 1, 2001 to 2008; group 2, 2009 to 2014. There were 407 patients (314 males, 93 females) who underwent open PAAA repair. There were 284 patients in group 1 and 123 in group 2, with an average of 35.5 and 20.5 repairs per year, respectively. Approximately 75% of patients were male, with no difference between groups. Based on the Revised Cardiac Risk Index and Society for Vascular Surgery comorbidity score, a significantly higher percentage of patients in group 1 were high risk compared with group 2 (Table I). However, significantly fewer patients in group 1 (0.7%) had a prior endovascular aortic repair compared to group 2 (9.8%). Proximal clamp position was inter-renal in 99 (24.3%), suprarenal in 177 (43.5%), suprasuperior mesenteric artery in 98 (24.1%), and supraceliac in 33 (8.1%), with comparable position and times between groups. Mean total operative time increased from 345 minutes in group 1 to 372 minutes in group 2 (Table I). Early mortality (30 day or in-hospital) was 2% (8 patients) overall and was similar in groups 1 and 2 (1.8% and 2.4%, respectively). Postoperative hemodialysis (temporary or permanent) was required in 15 patients (3.7%), and similar at 4.2% in group 1 and 2.5% in group 2 (Table II). Risk factors associated with early mortality included Revised Cardiac Risk Index class IV risk, high Society for Vascular Surgery comorbidity score, supraceliac clamp position, and organ ischemia times. Contemporary early outcomes of open PAAA repair continue to be excellent. Although patients currently undergoing open repair have fewer medical comorbidities, a higher percentage have undergone prior endovascular repair. Poor outcomes remain associated with higher medical risk and prolonged operative and organ ischemia time.Table IPatient demographics, medical comorbidities, and intraoperative variablesVariableGroup 1, 2001-2008 (n = 284)Group 2, 2009-2014 (n = 123)Total (N = 407)P valueAge, mean (SD), years72.4 (7.6)71.7 (8.0)72.2 (7.7).44Sex, No. (%).21 Male224 (78.9)90 (73.2)314 (77.1) Female60 (21.1)33 (26.8)93 (22.9)SVS score, mean (SD)10.1 (5.2)7.2 (4.8)9.2 (5.2)<.0001RCRI class.027 Missing, No.011 II, No. (%)105 (37.0)57 (46.7)162 (39.9) III, No. (%)119 (41.9)52 (42.6)171 (42.1) IV, No. (%)60 (21.1)13 (10.7)73 (18.0)Prior endo AAA repair<.0001 Missing, No.101 No, No. (%)281 (99.3)111 (90.2)392 (96.6) Yes, No. (%)2 (0.7)12 (9.8)14 (3.4)Clamp position.17 Inter-renal, No. (%)71 (25.0)28 (22.8)99 (24.3) Suprarenal, No. (%)116 (40.8)61 (49.6)177 (43.5) Supra-SMA, No. (%)76 (26.8)22 (17.9)98 (24.1) Supraceliac artery, No. (%)21 (7.4)12 (9.8)33 (8.1)Renal ischemia time, mean (SD), min41.5 (23.5)40.9 (19.6)41.3 (22.4).80Operating room time.023 No.284123407 Mean (SD), min344.5 (109.5)372.2 (119.0)352.9 (113.0)AAA, Abdominal aortic aneurysm; RCRI, Revised Cardiac Risk Index Class; SD, standard deviation; SMA, superior mesenteric artery; SVS, Society for Vascular Surgery. Open table in a new tab Table IIPostoperative outcomesOutcomeGroup 1, 2001-2008 (n = 284)Group 2, 2009-2014 (n = 123)Total (N = 407)P valueEarly mortalitya.70 No, No. (%)279 (98.2)120 (97.6)399 (98.0) Yes, No. (%)5 (1.8)3 (2.4)8 (2.0)Dialysisb.57 No, No. (%)271 (95.8)118 (97.5)389 (96.3) Yes, No. (%)12 (4.2)3 (2.5)15 (3.7)aIncludes both in-hospital and <30 day mortality.bIncludes both temporary and permanent dialysis. Open table in a new tab