Gli aneurismi dell’aorta pararenale : definizione, classificazione, indicazione al trattamento chirurgico

The formidable impact derived by the endovascular correc tion (Fvar) of abdominal aorta aneurysms (AAA), has risen its classification aspects. The topographieal criteria has assumed importance in decisional diagnostic therapeutic strategy, especially in cases of so c,tiled pararenal aneurysms (PRAA). Delmition: PRAA defines aneurysm being involved unde- renal juxtarenal aorta (JRA), or more rarely, suprarenal aorta with normal aortic diameter at level of celiac (/RA), or more rarely, suprarenal aorta with normal aortic dm meter at level of celiac trunk. (.lassification: Phe morphologic topographic aspect is considered in function of selection or eligibility of patients to h.var or standard open surgery, in the need of a suprarenal clamping for the tailoring of proximal anastomosys or anchorage of endoprotesis. Various specific classifications for tin ■se aneurysms have been proposed {Schumacher, 199"'; Wolf 2000; Ayari, 2001) that considers: Aneurysm collar: short/long/tortuous Relations with renal arteries .i Relations with the left renal vein Directions for surgical treatment: Phe choice between the technical solution to prefer either open or cndovascular surgery 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 n> be given to evaluating, using shared morphologic-topographical das sification criteria, real incidence of PRAA-JRA (A°o-20% in literature review); greater post opening mortality (l,.i"o- 15,j°-o); dimensions (AAA with diameter a 5,') cm in ope rating risk assessment of single patient, in clinic,d evolution and increase in the tune iff the lesion); m common occu ranee 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. Copyright