CLINICAL CASES   

Giornale Italiano di Chirurgia Vascolare 2000 March;7(1):53-64

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: English, Italian

Obstructive atherosclerotic disease of juxtarenal aorta. Case report and technical comments on surgical approach

Mavaro G., Martino A., Pumilia G., De Stefani S., La Barbera G.

From the Divisione di Chirurgia Vascolare (Primario Dott. A. Martino) Azienda Ospedaliera Civico Benfratelli, Palermo, Italy

Back­ground. In approx­i­mate­ly 5% of ­patients, obstruc­tive ath­e­ros­cle­rot­ic ­lesions of the abdom­i­nal aor­ta are local­ized at the jux­ta­ren­al lev­el. Revas­cu­lar­iza­tion in ­these cas­es ­includes tech­ni­cal var­i­ants depend­ing on the ­need for suprar­en­al clamp­ing. The ­authors ­describe a ­case of jux­ta­ren­al aor­tic occlu­sion and pro­vide a ­detailed descrip­tion of the par­tic­u­lar sur­gi­cal tech­nique ­used, com­par­ing the ­results ­with ­those report­ed in stud­ies emerg­ing ­from a “Med­line” ­search for the peri­od 1989-1999.
­Case ­report. A ­female 55-­year-old ­patient suf­fer­ing ­from bilat­er­al glu­teal claud­i­ca­tion, who had under­gone neph­rec­to­my 25 ­years ear­li­er for kid­ney dona­tion, was hos­pi­tal­ized fol­low­ing the ­onset of rest­ing ­pain ­over the ­past few ­months. Arter­i­og­ra­phy ­showed obstruc­tion of the jux­ta­ren­al abdom­i­nal aor­ta and the ­iliac ­axes. The ­patient under­went aor­to­bif­e­mo­ral ­bypass fol­low­ing suprar­en­al aor­tic clamp­ing.
­Results. No anom­a­lous ­renal func­tion was ­observed post­op­er­a­tive­ly in ­spite of suprar­en­al aor­tic clamp­ing ­with down­stream ische­mia last­ing 15 min­utes. Lym­phor­rhage aor­tic drain­age from ­resolved spon­ta­ne­ous­ly on day 14. The ­patient was dis­missed on day 18.
Con­clu­sions. If car­ried out in com­pli­ance ­with a num­ber of sur­gi­cal require­ments, suprar­en­al aor­tic clamp­ing ­allows obstruc­tive ­lesions of the jux­ta­ren­al abdom­i­nal aor­ta to be treat­ed ­with the min­i­mum ­risk of ­renal ischem­ic ­lesions.