Management of XXXX .

@entity1 @entity8 @entity296 @entity449 @entity101 @entity177 @entity439 @entity432 @entity731
The operative treatment of 77 @entity1 with @entity731 of the pararenal aorta (54 juxtarenal and 23 suprarenal) is analyzed. Repair of these complex lesions is formidable because of difficult exposure, @entity8 and @entity296 as a result of proximal @entity432 , and associated @entity8 with @entity8 . Nineteen (25%) @entity1 were normotensive with normal renal function. Sixteen @entity1 (21%) had @entity101 alone and 42 (54%) were @entity101 with @entity8 . There were @entity8 in 22% of @entity1 . Aortic reconstruction involved infrarenal graft in 27 @entity1 (35%), infrarenal graft plus pararenal aortic endarterectomy (TEA) in 26 (34%), and infra- and pararenal aortic graft in 24 (31%). Twenty-two @entity1 (30%) had normal renal arteries and therefore no renal reconstruction. Of the 55 @entity1 who required combined aortic and renal artery repair, 24 required renal artery repair because of involvement of the renal arteries by the @entity439 and 31 because of @entity8 . TEA was the most common technique of renal artery repair (54 of 93 arteries, 58%), followed by reimplantation (18 arteries) and prosthetic graft (13). The perioperative mortality rate was 1.3%. The perioperative morbidity rate was 28% and consisted principally of @entity177 (23%). This was usually transient (44%) and (89%) mild. Renal morbidity was adversely affected by @entity8 status, severity of @entity8 and extent of renal revascularization. Following reconstruction, @entity101 was cured or improved in 77% of @entity1 and @entity8 was cured or improved in 46% and stabilized in an additional 39% of @entity1 . These results show that combined @entity449 repair and renal artery reconstruction can be performed with minimal mortality and an acceptable morbidity. Aggressive intraoperative monitoring is necessary to minimize @entity296 . Careful attention must be paid to the technical details of the reconstruction, especially in minimizing @entity8 , to reduce the subsequent incidence of @entity177 .
