The role of open and endovascular treatment with fenestrated and chimney endografts for patients with juxtarenal aortic aneurysms

Objective: To present endovascular techniques in the treatment of juxtarenal aortic aneurysms (JAAAs) in relation to surgical repair; this is the "gold standard." Methods: Between January 2008 and December 2010, 90 consecutive patients were diagnosed with primary degenerative JAAAs (>= 5.0 cm) and assigned prospectively to different operative strategies on the basis of morphologic and clinical characteristics. In particular, 59 patients were treated by endovascular means such as fenestrated endovascular abdominal aortic repair (f-EVAR, n = 29) or chimney endovascular abdominal aortic repair (ch-EVAR, n = 30) endografting, and 31 patients underwent open repair (OR, n = 31). Results: Early procedure-related and all-cause (30-day) procedure-related mortality was 0% for the endovascular group and 6.4% (n = 2/31) for the OR group, due to systemic inflammatory response syndrome with consecutive multi-organ failure (P = .023). Persistent postoperative hemodialysis occurred only after OR (2/31; 6.4%). The overall estimated pre- and postoperative median estimated glomerular filtration rate and creatinine values were similar in the three subgroups. There was one left renal artery occlusion for each endovascular subgroup, which presented as flank pain and was treated by iliaco-renal bypass in both cases. Transfusion requirements and length of hospital stay were significantly less in the endovascular group (P = .014 and P = .004, respectively). Conclusions: Endovascular treatment of JAAA is a safe alternative for the short-term management of JAAA. (J Vasc Surg 2012;56:285-90.)