Outcomes after abdominal aortic aneurysm repair requiring a suprarenal cross-clamp

Abstract

Objective: The objective of this study was to analyze the early and late outcomes of patients who require a suprarenal aortic cross-clamp during elective open repair of an abdominal aortic aneurysm (AAA).

Methods: Patients from 1998 to 2012 who required a suprarenal aortic cross-clamp during elective open AAA repair were reviewed. Data abstracted included demographics and comorbidities; preoperative, perioperative, and late renal function; late interventions related to AAA repair; and late mortality. A decrease in renal function was defined as a >30% decline in estimated glomerular filtration rate (eGFR) compared with the preoperative value. Primary outcomes included renal function, intervention-free survival, and overall survival.

Results: During the study period, 211 patients underwent open elective or urgent AAA repair; 69 required a suprarenal cross-clamp. The mean age was 71 years, and 80% were men. The mean preoperative creatinine concentration was 1.2 mg/dL, and the mean preoperative eGFR was 66 mL/min/1.73 m2. Location of the aortic cross-clamp was suprarenal (37), supramesenteric (21), and supraceliac (11). Perioperatively, 21 patients (30%) experienced a significant decrease in eGFR; four patients required hemodialysis. Six patients had full recovery of renal function by discharge. Perioperative morbidity and mortality were 35% and 4%, respectively. At a mean follow-up of 3 years, seven patients had an eGFR significantly less than the preoperative value. Late interventions related to the AAA repair were required in eight patients. Indications included wound complication (3), anastomotic aneurysm (2), incisional hernia (1), anastomotic graft stenosis (1), and proximal aortic dilation (1). Overall 5-year intervention-free survival was 62% and overall survival 77%. Intervention-free survival was enhanced by antiplatelet use (P = .04), whereas overall survival was decreased by chronic obstructive pulmonary disease (P = .003) and perioperative pneumonia (P = .001).

Conclusions: More than a quarter of patients requiring a suprarenal cross-clamp during open AAA repair experience renal dysfunction. Late graft-related complications are few, with preoperative and perioperative pulmonary function negatively affecting overall patient survival.