The best treatment of juxtarenal aortic occlusion is and will be open surgery

Abstract

Occlusion of the infrarenal aorta (IAO) represents from 3% to 8.5% of aortoiliac occlusive diseases, and is a variant of TransAtlantic Inter-Society Consensus (TASC) Type D lesions. Two different patterns of IAO can be identified: Distal and proximal, or iuxtarenal. The former typically spares the origin of the inferior mesenteric artery, and is associated with the classic Leriche clinical triad. The latter extends cephalad approaching the level of the renal arteries, and may also cause acute renal failure, intestinal infarction, and even paraplegia due to the proximal propagation of aortic thrombosis. Endovascular treatment for TASC Type C and D lesions as a whole provides impressive results in terms of periprocedural morbidity, secondary patency rates, and of course less invasivity in comparison to open surgery. However, when complete aortic occlusions, and particularly juxtarenal occlusion, are specifically addressed, the reported results are in fact sobering, both in terms of technical success rates, and perioperative complications. Surgery repair of juxtarenal aortic occlusion, namely aortic endarterectomy and bypass grafting, is a challenging procedure that requires almost invariably aortic cross-clamping above the level of the renal arteries, and may be associated with significant morbidity and mortality. Nevertheless, it currently provides unmatched perioperative and long-term results, and should be regarded as the treatment of choice.