Sovrarenal aortic cross-clamping in the elective surgery of the abdominal aortic aneurysms

The authors discuss technical details and risks of sovrarenal aortic cross-clamping (acute renal and myocardial failure, spinal damage, lesions of mesenteric vessels, increase of blood loss) on the ground of Literature review and their recent personal experience of 10 cases (3.41% of elective aortic substitutions for aneurysm performed in the last 4 years). This technique is absolutely necessary in pararenal (juxtarenal and sovrarenal) aneurysms but it is extremely useful also in infrarenal aneurysms when 1) differential diagnosis between infra and juxtarenal aortic aneurysms is not sure with preoperative tests and intraoperative examination; 2) cranial limit of the infrarenal aneurysm is too short or fragile; 3) direct exploration of the origins of renal arteries seems to be necessary because of the uncertain presence of obstructive lesions with preoperative tests. In these cases infrarenal aortic cross-clamping can produce the following risks: 1) to perform the aorto prosthetic anastomosis in a pathologic aortic area, with possible 'recurrent' sovra-anastomotic aneurysm and lackage at medium or long time postoperatively; 2) immediate or early embolization of the renal territory owing to mobilization of perirenal atheromasic plaques; 3) embolization of the lower limbs; 4) unsuccessful exploration of uncertain lesions at the origin of the renal arteries. The authors' results induce the use of this technique in the above mentioned aortic substitutions, because the 10 cases in which the technique has been employed (9 juxtarenal and 1 suprarenal aortic aneurysms) mortality was nil and morbidity was only a slight and temporary increase of serum creatinine in 3 cases.