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Poster Competition

(PC014) Long Term Outcomes Following Open Juxtarenal Abdominal Aortic Aneurysm Repair—Degeneration of Remnant Aorta and Need for Re-intervention.

Friday, June 6, 2025
12:30 PM - 2:00 PM CT

    Submitting & Presenting Author(s)

  • Yazen Qumsiyeh, MD

    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
    Rochester, Minnesota

    • Co-Author(s)

  • VV

    Venkata Vineeth Vaddavalli

    Research Fellow
    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
    Rochester, Minnesota

  • AB

    Aaron C. Baker

    Kaiser Permanente, San Francisco, California, USA
    Oakland, California

  • Audra A. Duncan, MD (she/her/hers)

    Chair/Chief Division of Vascular and Endovascular Surgery
    University of Western Ontario
    London, Ontario

  • Randall R. Demartino, MD

    Associate Professor of Surgery
    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
    Rochester, Minnesota

  • Jill J. Colglazier, MD

    Assistant Professor of Vascular Surgery
    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
    Rochester, Minnesota

  • Fahad Shuja, MBBS

    Assistant Professor of Vascular and Endovascular Surgery
    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
    Rochester, Minnesota

  • Bernardo C. Mendes, MD

    Professor of Surgery
    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
    Rochester, Minnesota

  • Thomas C. Bower, MD

    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
    Rochester, Minnesota

    • Senior Author(s)

  • Manju Kalra, MBBS

    Professor of Surgery
    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
    Rochester, Minnesota

Objectives: The fate of remnant aneurysmal or ectatic aortic segments and the need for re-intervention following open juxtarenal aortic aneurysm(JRAA) repair remains ill-defined. The aim of this study was to assess long-term outcomes of open JRAA repair, specifically morphological changes of remnant proximal aortic tissue and need for re-intervention at this site.

Methods: Data from consecutive patients who underwent elective open JRAA repair from January 2001 to December 2020 were retrospectively analyzed. Demographics, pre-operative risk factors, re-intervention and mortality were evaluated. Aortic diameter changes were evaluated on post-operative CT scans during long term follow up. Outer aortic diameter measurements were performed at 4 levels: renal(RA), suprarenal(SRA), supramesenteric(SMA) and supraceliac(CA).

Results: There were 268 patients (M/F;125/36) with a median age of 72.5 years (51 to 93). Risk factors included: coronary artery disease 49.6%, renal insufficiency (serum creatinine > 1.5mg/dL) 24.8%, pulmonary disease 45.9%. Mean SVS / AAVS risk score was 7.8±4.7 (median 7.0, range 0-22). The proximal anastomosis was sewn to normal aorta( < 30mm) in 166 patients and to ectatic aorta(≥30mm) in 82 patients. Thirty-day mortality was 1.5%, temporary and permanent hemodialysis were 2.6% and 1%, respectively. Median clinical and imaging follow up were 7.2 years (range:4 days-18.8 years) and 58 months (0 to 225) respectively. On 209 CT scans available (80% of normal aorta, 90% of ectatic aorta), median aortic growth (range) was 0mm (0 to 21) at RA, 1mm (0 to 42) at SRA, 1mm (0 to 20) at SMA, and 1mm (0 to 30) at CA.(Table I). The pararenal aorta degenerated to > 5mm in 18% and > 10 mm in 5.7% of patients; 4 patients met criteria for repair. FEVAR was performed in 2 patients at 10 and 15 years, for ruptured anastomotic pseudoaneurysm and saccular degeneration respectively; the 2 other patients were denied repair because of age and medical comorbidities. Any re-intervention was performed in 11 further patients (remote aortoiliac =7, incisional hernia=4). During follow up, 148 patients died; 1 of 3 aortic-related deaths was from pararenal aortic degeneration, 2 from isolated descending thoracic aortic rupture. On Kaplan Meier analysis overall and re-intervention free survival at 3, 5 and 10 years were 90.3%, 81.2% and 49.7% and 88.4%, 80.1%, and 48.1%.(Figure1).

Conclusions: Growth of remnant paravisceral aortic segments following open JRAA repair is slow and only a minority of patients require re-intervention during their lifetime. Open repair remains a safe and durable treatment option for medically appropriate risk patients.