While occlusive lesion at the terminal aorta is frequently observed, aortic obliteration at or above the level of renal artery is infrequently seen. Juxtaronal aortic occlusion (JRAO) defined as occlusive lesion involving the aortic segment
immediately
beneath the level of the renal artery usually results from slow proximal progression of distal aortic thrombus. The two major goals of the surgical treatment for JRAO are improvement of limb perfusion and elimination of potentials for cephalad
propagation of aortic thrombus that, eventually, may lead to renal or visceral artery ischemia.
The keys in the operation for JRAO are suprarenal aortic control and stadard infrarenal aortic repair. Suprarenal aortic clamping carries risks of incresed cardiac stress and renal ischemia.
During the period from March, 1991 to February, 1994, we experienced 52 patients with chronic aortoiliac occlusive disease. Suprarenal aortic clamping were required in the patients with 7 JRAO, 2 juxtarenal aortic obliteration, and 1 suprarenal
aortic
occlusion for aortobifemoral bypass. The sites selected for suprarenal aortic clamping were the aortic segment between superior mesenteric artery and renal artery in 9 and supraceliac abdominal aorta in 1. Aortic clamping time was shorter than 20
minutes in all cases.
To determine the effect of temporary, suprarenal aortic clamaping, we compared preoperative serum creatinine values with them at postoperative third day. The results revealed no evidence or fenal functional impairment after temporary, suprarenal
aortic
clamping (mean preoperative serum creatinine : 1.20 mg/dl vs mean postoepertive serum creatinine: 1.13 mg/dl).
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