ABDOMINAL AORTIC-ANEURYSM - CT EVALUATION OF RENAL-ARTERY INVOLVEMENT

PURPOSE: To determine whether computed tomography (CT) assessment of t he proximal extent of ruptured aneurysms can help the surgeon determin e whether to initially clamp the pararenal aneurysm neck or the suprac eliac aorta. MATERIALS AND METHODS: CT scans and medical records were reviewed and compared for 30 patients with ruptured abdominal aortic a neurysms (AAAs) who underwent immediate surgical repair. RESULTS: For 49 of 50 vessels in 25 patients, the authors correctly predicted at CT that AAAs originated caudal to the main renal artery origins. They al so predicted that nine main renal arteries in five patients originated directly from the AAAs, but this was correct in only five arteries. S uprarenal clamping was required in all five patients. Infrarenal clamp s were used before reconstruction in all 12 of the patients whose AAAs appeared to originate at least 30 mm below the main renal arteries. C ONCLUSION: CT can help predict whether an initial aortic clamp can be placed caudal to the main renal artery orifices. Its use can be predic ted with 100% certainty only when an aneurysm appears to originate at least 3 cm caudal to the origin of the main renal artery.