PERIOPERATIVE MANAGEMENT OF JUXTARENAL AORTIC OCCLUSION

The authors reviewed the surgical treatment and outcome in patients wi th juxtarenal aortic occlusion. From 1975 to 1993, 44 patients (37 men ) with a mean age of 62.6 years underwent surgery for this condition. The vascular lesions included renal-level segmental aortic occlusion i n 2 patients, infrarenal complete aortic occlusion in 30, and high aor tic occlusion with a patent inferior mesenteric artery in 12. Four pat ients had subacute occlusion and 40 had chronic occlusion. In the chro nic group, the symptom was intermittent claudication in 31 cases, rest pain in 4, and gangrene or ulceration in 5. Impotence was present in most of the men. Surgical treatment included transaortic thromboendart erectomy in 2 patients, axillobifemoral bypass in 12, and high aortic thromboendarterectomy plus aortobifemoral bypass in 29. Suprarenal aor tic clamping was done in 22 patients, with a mean renal occlusion time of 9.3 minutes. Simultaneous renal artery reconstruction was performe d in 3 patients. There were 4 operative deaths (mortality rate 9%), wi th 2 in the subacute group. Late death from unrelated causes occurred in 9 patients within five years. Lower limb ischemia was cured in all patients and impotence cured in 4 cases. Graft patency was satisfactor y after both extra-anatomic and anatomic bypass. Transanal Doppler ult rasound monitoring during the surgery was easy to set and gave the aut hors useful information about accurate visceral circulation in referen ce to aortic reconstruction.