This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Renal dysfunction and prolonged visceral ischaemia increase mortality rate after suprarenal aneurysm repair. BJS 2003; 90: 1142-1146.
Published: 11th July 2003
Authors: C. D. Bicknell, A. R. Cowan, M. I. Kerle, A. O. Mansfield, N. J. W. Cheshire, J. H. N. Wolfe et al.
Background
Elective juxtarenal abdominal aneurysm repair has a significantly lower mortality rate than suprarenal repair. Identification of factors affecting outcome may lead to a reduction in mortality rate for suprarenal repair.
Method
Data were collected prospectively between 1993 and 2000 for 130 patients who underwent type IV thoracoabdominal aneurysm (TAA) repair and 44 patients who had juxtarenal aneurysm (JRA) repair. Preoperative risk factors and operative details were compared between groups and related to outcome after TAA repair (there were only two deaths in the JRA group).
Results
The in‐hospital mortality rate was significantly higher following TAA repair (20·0 per cent; 26 of 130 patients) than JRA repair (4·5 per cent; two of 44). Raised serum creatinine concentration was the only preoperative factor (P = 0·013) and visceral ischaemia the only significant operative factor (P = 0·001) that affected mortality after TAA repair.
Conclusion
JRA repair was performed with similar risks to those of infrarenal aneurysm repair. Impaired preoperative renal function was related to death following TAA repair and conservative treatment should be considered for patients with a serum creatinine level above 180 µmol/l. Reducing the duration of visceral ischaemia might improve outcome. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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