PARARENAL AORTIC ANEURYSMS: DEFINITION, CLASSIFICATION, DIRECTIONS FOR SURGERY

Abstract

The formidable impact derived by the endovascular correc tion (Evar) of abdominal aorta aneurysms (AAA), has risen its classification aspects. The topographical criteria has assu med importance in decisional diagnostic-therapeutic strategy, especially in cases of so called pararenal aneurysms (PRAA).

Definition: PRAA defines aneurysm being involved unde renal juxtarenal aorta (JRA), or more rarely, suprarenal aorta with normal aortic diameter at level of celiac (JRA), or more rarely, suprarenal aorta with normal aortic dia meter at level of celiac trunk.

Classification: The morphologic-topographic aspect is con sidered in function of selection or eligibility of patients to Evar or standard open surgery, in the need of a suprare nal clamping for the tailoring of proximal anastomosys or anchorage of endoprotesis. Various specific classifications for these aneurysms have been proposed (Schumacher, 1997; Wolf, 2000; Ayari, 2001) that considers:
1. Aneurysm collar: short/long/tortuous
2. Relations with renal arteries
3. Relations with the left renal vein

Directions for surgical treatment: The choice between the technical solution to prefer either open or endovascular sur gery will have to consider a series of additional variables to the standard direction common to every AAA based on dimensions and morphology. Priority will have to be given to evaluating, using shared morphologic-topographical clas sification criteria, real incidence of PRAA-JRA (3%-20% in literature review); greater post opening mortality (1,3%15,3%); dimensions (AAA with diameter 5,5 cm in ope rating risk assessment of single patient, in clinical evolution and increase in the time of the lesion); in common occu rance in AAA of steno-obstructive lesions of renal arteries and involvement of same ones in the aneurysm collar in need of reconstruction and suprarenal aortic clamping.