THE JUXTARENAL ABDOMINAL AORTIC-ANEURYSM - A MOVE COMMON PROBLEM THANPREVIOUSLY REALIZED

Objective: To determine the incidence and treatment outcome of juxtare nal infrarenal aneurysmectomy in a vascular practice minimally biased by tertiary referral. Design: A 5-year retrospective review of all aor tic operations from our vascular registry was performed, and a case se ries of juxtarenal aneurysmectomies was analyzed. Patients: Of 174 inf rarenal aortic aneurysmectomies performed, 27 (15.5%) (95% confidence interval, 10.5% to 21.8%)involved the juxtarenal aorta. Interventions: Juxtarenal involvement was unsuspected but found by aortography in 25 (93%) of 27 cases. Resection was performed transabdominally in 20 cas es (74%) and retroperitoneally in seven cases (26%). Main Outcome Meas ures: Incidence, operative technique, morbidity, and mortality were an alyzed and compared with those of historical controls. Results: The in cidence of juxtarenal aneurysmectomy was 15.5%. No operative deaths oc curred, but there was a 19% incidence of surgical morbidity (including a 7% incidence of transient renal failure). The late survival rate wa s 89% (follow-up, 1 to 53 months; mean, 18 months). Conclusions: Juxta renal aortic aneurysms are not uncommon. Successful management is poss ible, even outside the large referral center.