BACKGROUND A juxtarenal abdominal aortic aneurysm is defined as a short (less than 4 mm) or no-neck aneurysm, which is often treated with open or complex endovascular repair. The evidence to support the best treatment strategy is scarce. The aim of this study was to assess the short- and mid-term outcomes of elective open surgical repair or fenestrated endovascular aneurysm repair for juxtarenal abdominal aortic aneurysms in Sweden. METHODS Patients who underwent elective open surgical repair or fenestrated endovascular aneurysm repair for juxtarenal abdominal aortic aneurysms between 2018 and 2021 were identified in the Swedish Vascular Registry. Demographics, practice patterns, and operative details were assessed. The primary outcome was 30-day mortality. Secondary outcomes included perioperative complications and mid-term survival. RESULTS Among 3777 aortic aneurysm repairs performed, 418 involved juxtarenal abdominal aortic aneurysms (open surgical repair 228 (54.5%), fenestrated endovascular aneurysm repair 176 (42.1%), chimney endovascular aneurysm repair 6 (1.4%), and branched endovascular aneurysm repair 8 (1.9%)). Some 25 centres performed juxtarenal abdominal aortic aneurysm repairs with open surgical repair and fenestrated endovascular aneurysm repair. The caseload varied from 2 to 54 repairs per centre. The mean aneurysm diameter was 61 mm. Endovascularly treated patients were older and had more pulmonary co-morbidities. The 30-day mortality rate was 2.2% (open surgical repair 2.6% and fenestrated endovascular aneurysm repair 1.7%; P = 0.397). Perioperative major complications occurred in 14.1% of patients (open surgical repair 19.3% and fenestrated endovascular aneurysm repair 7.4%; P < 0.001) and perioperative vascular complications occurred in 12.1% of patients (open surgical repair 8.8% and fenestrated endovascular aneurysm repair 11.9%; P = 0.190). The survival rate (estimated using Kaplan-Meier analysis) at 1 year and 3 years was 93.1% and 85.9% respectively for open surgical repair and 95.2% and 80.9% respectively for fenestrated endovascular aneurysm repair (P = 0.477). CONCLUSION This nationwide study reveals considerable variations in volume and treatment strategy between Swedish centres performing juxtarenal abdominal aortic aneurysm repairs. Survival is comparable for open surgical repair and fenestrated endovascular aneurysm repair, although there are significant baseline demographic differences between patients selected for the two treatment modalities.

中文翻译：

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瑞典肾旁腹主动脉瘤择期开放手术修复或开孔血管内动脉瘤修复的结果。


背景 近肾腹主动脉瘤定义为短（小于 4 毫米）或无颈动脉瘤，通常采用开放性或复杂血管内修复治疗。支持最佳治疗策略的证据很少。本研究的目的是评估瑞典肾旁腹主动脉瘤择期开放手术修复术或开窗血管内动脉瘤修复术的短期和中期结局。方法 在瑞典血管登记处确定了 2018 年至 2021 年间接受择期开放手术修复或开孔血管内动脉瘤修复治疗近肾腹主动脉瘤的患者。评估了人口统计学、实践模式和手术细节。主要结局是 30 天死亡率。次要结局包括围手术期并发症和中期生存率。结果 在进行的 3777 例主动脉瘤修复中，418 例涉及肾旁腹主动脉瘤 （开放手术修复 228 例 （54.5%），开窗血管内动脉瘤修复 176 例 （42.1%），烟囱式血管内动脉瘤修复 6 例 （1.4%），分支血管内动脉瘤修复 8 例 （1.9%））。大约 25 个中心进行了肾旁腹主动脉瘤修复术，包括开放手术修复术和开孔血管内动脉瘤修复术。每个中心的病例量从 2 到 54 次不等。平均动脉瘤直径为 61 mm。血管内治疗的患者年龄较大，肺部合并症更多。30 天死亡率为 2.2% （开放手术修复 2.6% 和开孔血管内动脉瘤修复 1.7%;P = 0.397）。围手术期主要并发症发生率为 14.1% 的患者 （开放手术修复术 19.3% 和有孔血管内动脉瘤修复术 7.4%;P < 0.001） 和围手术期血管并发症发生率为 12 例。1% 的患者 （开放手术修复术 8.8% 和开孔血管内动脉瘤修复术 11.9%;P = 0.190）。开放手术修复术 1 年和 3 年生存率 （使用 Kaplan-Meier 分析估计） 分别为 93.1% 和 85.9%，开孔血管内动脉瘤修复术分别为 95.2% 和 80.9% （P = 0.477）。结论 这项全国性研究揭示了瑞典进行近肾腹主动脉瘤修复的中心在体积和治疗策略方面存在相当大的差异。开放手术修复术和开孔血管内动脉瘤修复术的生存率相当，尽管选择两种治疗方式的患者之间存在显著的基线人口学差异。