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Long Term Outcomes Following Open Juxtarenal Abdominal Aortic Aneurysm Repair - Degeneration Of Remnant Aorta And Need For Re-intervention
Venkata Vineeth Vaddavalli, MBBS1, Yazen Qumsiyeh, MD
2, Audra Duncan
3, Randall R. DeMartino, MD, MS
2, Jill Colglazier, MD
2, Fahad Shuja, MBBS
2, Manju Kalra, MBBS
2.
1University of Texas Health Science Center, Houston, TX, USA,
2Mayo Clinic, Rochester, MN, USA,
3London Health Sciences Center Victoria Hospital, Western University, London, ON, Canada.
OBJECTIVES: Fate of remnant aneurysmal or ectatic aortic segments and need for re-intervention following open juxtarenal aortic aneurysm (JRAA) repair remains ill-defined. The aim of this study was to assess long-term outcomes of open JRAA repair, specifically morphological changes of remnant proximal aortic tissue and need for re-intervention at this site.
METHODS: Data from consecutive patients who underwent elective open JRAA repair from January 2001 to December 2020 were retrospectively analyzed. Outer aortic diameter measurements were performed at 4 levels: renal(RA), suprarenal(SRA), supramesenteric(SMA) and supraceliac(CA).
RESULTS: There were 268 patients (M/F;211/57) with a median age of 72.5years. Median SVS / AAVS risk score was 7(0-22). Proximal anastomosis was sewn to normal aorta(<30mm) in 166 and to ectatic aorta(≥30mm) in 82 patients. Thirty-day mortality was 1.5%, temporary and permanent hemodialysis were 2.6% and 1%, respectively. Median clinical and imaging follow up were 7.2 years(4 days-18.8 years) and 58 months(0 to 225) respectively. On 209 CT scans available, median aortic growth(range) was 0mm(0 to 21) at RA, 1mm(0 to 42) at SRA, 1mm(0 to 20) at SMA, and 1mm(0 to 30) at CA
(Table I). Pararenal aorta degenerated to > 5mm in 18% and > 10 mm in 5.7% of patients; four patients met criteria for repair. FEVAR was performed in two patients at 10 and 15 years, for ruptured anastomotic pseudoaneurysm and saccular degeneration respectively; other two patients were unfit because of medical comorbidities. Any re-intervention was performed in 11 patients (remote aortoiliac=7, incisional hernia=4).During follow up, 148 patients died. Aortic-related death occurred in three (1=pararenal aortic degeneration, 2=isolated descending thoracic aortic rupture). On Kaplan Meier analysis overall and re-intervention free survival at 3,5 and 10years were 90.3%, 81.2% and 49.7%, and 88.4%, 80.1%, and 48.1%, respectively
(Figure1).CONCLUSIONS: Growth of remnant paravisceral aortic segments following open JRAA repair is slow and only minority of patients require re-intervention during their lifetime. Open repair remains a safe and durable treatment option for medically appropriate risk patients.
Table I. Comparison of growth in aortic diameter at various levels| Aortic levels | Normal aortic remnant (<30mm)(N=133/166, 80%) | Ecstatic aortic remnant (>30mm)(N= 74/82, 90%) | p value |
| Renal | | | 0.403 |
| Mean (SD) | 1.35 (2.74) | 1.01 (2.9) | |
| Median (Range) | 0 (0 to 21) | 0 (0 to 21) | |
| Suprarenal | | | 0.064 |
| Mean (SD) | 1.48 (2.03) | 2.19 (3.46) | |
| Median (Range) | 1.0 (0 to 13) | 1.0 (0 to 20) | |
| Supramesenteric | | | 0.019 |
| Mean (SD) | 1.73 (2.26) | 2.69 (3.57) | |
| Median (Range) | 1.0 (0 to 18) | 2.0 (0 to 20) | |
| Supraceliac | | | 0.240 |
| Mean(SD) | 1.86(3.07) | 2.41(3.43) | |
| Median(Range) | 1.0(0to30) | 1.0(0to15) | |
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