Outcomes of supra-versus infra-renal clamping in elective open aortic aneurysm repair in a tertiary vascular center

Objective: Juxtarenal abdominal aortic aneurysms (AAAs), pose a greater surgical challenge than infrarenal AAAs and often require suprarenal aortic clamping during open repair. This study aims to assess the impact of suprarenal vs infrarenal clamping on short- and long-term renal outcomes, mortality, and reintervention rates. Methods: A retrospective cohort analysis was conducted on 1250 patients undergoing open AAA repair between 2000 and 2020 at a tertiary vascular center. Patients were stratified into suprarenal and infrarenal clamping groups. Outcomes included 30-day mortality, major adverse events, acute kidney injury, new-onset dialysis, chronic kidney disease (CKD), long-term mortality, and reintervention. Propensity score matching and multivariate analysis were used to adjust for confounders. Results: Of the cohort, 492 underwent suprarenal and 758 infrarenal clamping. The suprarenal group experienced higher 30-day major adverse events (20.9% vs 16.2%; P = .036), acute kidney injury (37.6% vs 22.0%; P < .001), and new-onset dialysis (4.5% vs 1.8%; P = .009). At a median follow-up of 8.6 years, CKD incidence was significantly higher in the suprarenal group (28.5% vs 21.1%; P = .004), as was all-cause mortality (41.3% vs 32.4%; P < .001). We found no difference in reintervention rates between groups. In the propensity-matched cohort, CKD remained significantly more common with suprarenal clamping (P < .001), whereas differences in mortality were not statistically significant. Conclusions: Suprarenal clamping during open AAA repair is associated with increased postoperative renal complications and long-term CKD and mortality, despite similar reintervention and short-term mortality rates. These findings support the need for individualized surgical planning.