Open Repair of Pararenal Aneurysms: Renal Vessel Surgical Management

Abstract

The proximal abdominal aorta constitutes a particular location for the dilative process of the aneurysms because the splanchnic vessels or the renal artery ostium may be involved. As a result, we can make a more specific classification of this type of aneurysms: • Juxtarenal infrarenal abdominal aortic aneu-rysms (JR-AAA): The proximal extension of the aneurysms starts adjacent or at the lower margin of the renal artery origins, without involving them in the dilative process. • Pararenal infrarenal abdominal aortic aneu-rysms (PR-AAA): One or both renal arteries are involved in the dilative process. • Suprarenal abdominal aortic aneurysms (SR-AAA): The splanchnic arteries and the renal artery origins are involved in the dilative process. 3.2 Epidemiology 3.2.1 Incidence The involvement of the proximal abdominal aorta takes place in 5-15% of all AAAs [1, 2]. AAAs mostly affect the population above 50 years of age; they are two to six times more frequent in men than women and two to three times more common in people of Caucasian descent than in other populations [3-5]. Screening studies have provided us with important information on the incidence and prevalence of this disease: for men above 50 years of age, an incidence of 3.5 for 1000 people/year [6] was shown, while new-onset AAAs were discovered in only 2% of patients at a second examination performed after a mean time of 5.5 years, after a negative result upon first examination. Overall, the incidence by age of ruptured and symptomatic P-AAAs, and the mortality rate of P-AAAs, is six times greater in men than in women. A significant increase in the incidence of asymptom-atic AAAs has been observed over the last two decades [7, 8], which may be due to increased diagnostic detection. However, there is emerging proof of a plateau reached by hospitalization numbers for aortic aneurysm repair, perhaps owing to health policies which are finalized to reduce the morbidity and mortality of cardiovas-cular diseases.