Abstract:Background and Aims Juxtarenal abdominal aortic occlusion is an extreme condition of aortoiliac occlusive disease, and its treatment is often challenging. Although endovascular therapy is suitable for such patients, there are still some indications for open surgery. This study was performed to evaluate the efficacy of open surgery for juxtarenal abdominal aortic occlusion and summarize the experience and its treatment strategies.Methods The clinical data of 10 patients with juxtarenal abdominal aortic occlusion undergoing open surgery from July 2018 to May 2022 were collected. The general information, surgical procedures, operative time, intraoperative blood loss, methods for blockage of the blood flow through the abdominal aorta, duration of cross-clamping of the suprarenal abdominal aorta, surgical complications and degree of symptom relief as well as the follow-up results were retrospectively analyzed.Results Operation was successfully completed in all the 10 patients. The operative time was 210 to 420 min with a median operative time of 265 min; the intraoperative blood loss was 200 to 1 200 mL with a median blood loss of 375 mL. The prosthetic bypass from the subphrenic abdominal aorta to bilateral femoral arteries was established in 3 patients, of whom, one case underwent simultaneous amputation; the prosthetic bypass from the subphrenic abdominal aorta to bilateral common iliac arteries with inferior mesenteric artery reconstruction was used in one patient; the prosthetic bypass from the subrenal abdominal aorta to bilateral femoral arteries was created in 5 patients; the prosthetic bypass from the axillary artery to bilateral femoral arteries with carotid endarterectomy was performed in one patient. Subphrenic aortic cross-clamping was performed in 4 cases, sequential cross-clamping of the suprarenal and subrenal aorta was performed in 1 case, and subrenal aortic cross-clamping was performed in 4 cases. The time for subphrenic aortic cross-clamping was 14 to 20 min with a median time of 20 min. No cardiac-cerebrovascular accidents, operative death, renal dysfunction and prosthesis infection occurred during perioperative period. After operation, symptom of intermittent claudication or resting pain was relieved in all the 10 patients, and the pulses of bilateral dorsalis pedis and posterior tibial arteries were palpable. In the 10 patients, follow-up was conducted for 4 to 40 months with a median follow-up time of 27 months, during which time, all prosthetic grafts remained patent, and no anastomotic stenosis, lower limb ischemia and intestinal ischemia were noted.Conclusion Open surgery has demonstrable efficacy in the treatment of juxtarenal abdominal aortic occlusion, with a high long-term patency of the bridging vessels. Individualized treatment should be adopted according to different situations.