Prosthetic sleeve reinforcing for juxtarenal abdominal aortic aneurysm: experience of 30 cases.

OBJECTIVE Endovascular repair remains a challenge in the treatment of juxtarenal abdominal aortic aneurysms (AAAs); open surgery is now the treatment of choice. Because the proximal anastomosis involves a fragile aortic wall and renal ischemic time is correlated with postoperative renal dysfunction, simple and secure reinforcing of the suture line is indispensable in juxtarenal AAA repair. Our report describes the efficacy of prosthetic sleeve reinforcing (PSR) for this repair. PATIENTS AND METHODS From 2005 to 2009, 30 patients, including 4 with ruptured aneurysms, underwent juxtarenal AAA repair with PSR. We reviewed their in-hospital and midterm outcomes. RESULTS Mean renal ischemic time was 26 ± 5.5 min. Mean hospital length of stay was 19 days; including 4 cases of ruptured juxtarenal AAA, there were no mortalities. Three patients with preoperative renal dysfunction, including 2 with aneurysmal rupture, required temporary renal replacement therapy. The overall survival rate was 93% (28/30). There was no case of postoperative graft-related complications, including anastomotic pseudoaneurysm and graft-enteric fistula. CONCLUSION PSR enables secure and prompt proximal anastomosis, preventing postoperative morbidity and late graft-related complications. We conclude that PSR could be a valuable method for juxtarenal AAA repair.