Open and endovascular repair of infrarenal vs. juxtarenal abdominal aortic aneurysms

Background and objective This study investigated the differences in perioperative outcome after elective open repair (OAR) and endovascular repair (EVAR) of juxtarenal and infrarenal abdominal aortic aneurysms (AAA). Material and Methods Data of 18,629 patients of the AAA registry of the German Institute for Vascular Health Research (DIGG) of the German Society for Vascular Surgery and Vascular Medicine (DGG) treated in 2013-2017 were analyzed, 17,026 patients (91.4%) with infrarenal and 1603 (8.6%) with juxtarenal AAA. Of the infrarenal AAA 80.5% (n= 13,707) were treated with EVAR and 3319 (19.5%) with OAR. In the juxtarenal group 786 patients were treated with EVAR (49.0%) and 817 (51.0%) with OAR. Results In both OAR and EVAR patients with juxtarenal AAA were not comparable in their initial conditions with patients with infrarenal AAA. With juxtarenal AAA the proportion of women was significantly higher (for EVAR 16.9% vs. 13.1%, for OAR 18.6% vs. 16.0%) and the aneurysm diameter was significantly larger (for EVAR 57.8mm vs. 54.3mm, for OAR 59.0mm vs. 56.3mm). Patients with juxtarenal AAA showed a significantly higher frequency of preoperative renal function impairment than patients with infrarenal AAA (12.5% vs. 9.7% for EVAR, 14.4% vs. 9.4% for OAR). Hospital mortality with EVAR was 1.0% (infrarenal AAA) vs. 5.7% (juxtarenal AAA,p= 0.000), with OAR 4.2% (infrarenal AAA) vs. 7.7% (juxtarenal AAA,p= 0.000). Postoperative deterioration of kidney function occurred with EVAR in 2.0% of patients with infrarenal AAA vs. 12.2% for juxtarenal AAA (p= 0.000), with OAR in 7.9% vs. 19.5% (p= 0.000). Conclusions In the present analysis postoperative complications and postoperative mortality were significantly higher when treating juxtarenal AAA as compared to infrarenal AAA and this was true for EVAR as well as for OAR. It should be clarified in further studies to what extent this was due to less favorable initial conditions for patients with juxtarenal AAA and how the chosen surgical techniques affected the results.