Management of Abdominal Aortic Aneurysm in the Setting of Coexistent Renal and Splanchnic Disease

Abstract

By definition, an infrarenal abdominal aortic aneurysm (AAA) is located in the distal portion of the abdominal aorta, inferior to the renal arteries. The segment of aorta between the renal arteries and an infrarenal aneurysm is commonly referred to as the “neck” of the aneurysm. The anatomic character istics of this area are of critical importance when considering therapeutic strat egies for both open and endoluminal interventions. Prior to the endovascular era, optimal management of coexistent aortic aneurysmal disease and visceral pathology was somewhat controversial. While some centers advocated open endarterectomy for stenotic ostial lesions of the renal and visceral vessels at time of aneurysm repair, others preferred reimplantation or bypass for similar lesions. The choice of intervention was often individualized and based some what upon surgeon preference.

With the advent and the widespread uptake and utilization of endovascular techniques, it is readily evident that many infrarenal and thoracic aortic aneu-rysms can be repaired using intraluminal stent-graft devices. Furthermore, the successful deployment of fenestrated or branched stent-graft devices are expanding the limits of endoluminal aneurysm repair. Currently, the treatment of juxtarenal, suprarenal, or even thoraco-AAAs may now be performed solely via endoluminal techniques, albeit in clinical trials.

Optimal management of aortic aneurysm and coexisting arterial branch-vessel occlusive disease is predicated on a thorough knowledge of the anatomy, pathophysiology, clinical picture, natural history, and therapeutic options that are available for each of the underlying disease processes. A logical platform from which to commence evaluating these processes is to review the current understanding of stenotic lesions affecting the renal arteries, superior mesenteric artery, and the celiac artery.