OBJECTIVE: Surgical treatment of juxtarenal and pararenal @entity449 (JPAA) provide technical problems which may influence short- and long-term results; however few surgical series have been published on this subject. The purpose of this study is to observe predictors of results in a series of JPAA and to analyse long-term survival of these @entity1 . DESIGN, MATERIALS AND METHODS: @entity1 ' epidemiology and surgical technique used in all cases of JPAA were reviewed and correlated with early results through logistic regression analysis. Early results were compared with those of @entity439 ( @entity439 ) treated in the same period. Long-term results were obtained through our surveillance protocol (3 months after surgery and yearly thereafter) and calculated by life-table analysis. RESULTS: Fifty JPAA were identified over a total of 1450 @entity449 (3.4%). Surgical approach was: anterior transperitoneal in 38 cases (96%), extended retroperitoneal in one (2%) and thoracoabdominal in one (2%). Suprarenal control was obtained in all cases; at the diaphragm in seven (14%), above both renal arteries in 17 (34%) and above one renal artery in 16 cases (32%). Renal revascularisation was performed in 11 cases (22%; nine unilateral and two bilateral). Overall perioperative mortality was 12%, significantly greater than mortality of IAAs: 50/1400, 3.5% (p < 0.02). Mortality in elective cases was 3/42, 7.1% and in ruptured JPAA 3/8, 37.5%. Independent predictors of early mortality were @entity1756 , age > 70 years, and @entity453 . Gender, smoking, @entity101 , @entity6 , site of proximal aortic clamping, type of aortic reconstruction, visceral revascularisation, and technically difficult cases were not associated with early mortality. Three and five year survivals were 66.8% +/- 9.93 and 40.0% +/- 12.64, respectively. CONCLUSIONS: Surgical treatment of JPAAs is associated with a higher risk of early mortality compared to IAAs and reduced long-term survival. Indications for surgery in JPAAs should consider the risk/benefit ratio rather than focusing on technical aspects which do not seem to significantly influence results.

Early and long-term results in the surgical treatment of juxtarenal and pararenal XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity449 :: ('MESH:D001014', 'Disease') :: ['aortic aneurysms'] @entity101 :: ('MESH:D006973', 'Disease') :: ['hypertension'] @entity6 :: ('MESH:D003920', 'Disease') :: ['diabetes mellitus'] @entity439 :: ('MESH:D000783', 'Disease') :: ['IAA', 'infrarenal aneurysms'] @entity453 :: ('MESH:D003324', 'Disease') :: ['coronary artery disease'] @entity1756 :: ('MESH:D017542', 'Disease') :: ['aneurysm rupture']
@entity449 :: (MESH:D001014,Disease) :: ['aortic aneurysms']
