No abstract

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Objectives: To determine long-term outcomes of patients needing open renal revascularization (ORR) for stent failure.Methods: Retrospective review was conducted of consecutive patients operated on for renal stent failure from 1998 to 2013. End points were hypertension, renal function response, primary patency, reintervention, and overall and hemodialysis (HD)-free survival.Results: Of 878 ORR during this time, 37 patients (70% female; mean age, 63 6 10 years) had 41 arteries reconstructed for stent failure. Chronic kidney disease (CKD) was stage 2 in 8%, stage 3 in 70%, stage 4 in 19%, and stage 5 in 3%. Reconstructions (bypass 84%) were unilateral in 27 (mean glomerular filtration rate [GFR], 39.9 mL) and bilateral in 10 (mean GFR 47.1 mL). Twelve had ORR of a solitary kidney (mean GFR, 34.1 mL). Three procedure-related deaths occurred at 48, 65, and 210 days due to major adverse events. Overall, five patients needed HD (mean preoperative GFR 35.8 mL vs 43.7 mL in those without HD; P ¼ .29), and three were permanent (8%). Over a mean follow-up of 39 months (range, 2-112 months), mean systolic blood pressure decreased from 153.9 to 134.3 mm Hg (P ¼ NS), and there was a significant decrease in BP medications (2.98 before, 2.47 after; P ¼ .042). There was no change in serum creatinine (1.54 mg/dL before; 1.62 mg/dL after), GFR (43.9 mL before; 45.8 mL after), kidney length (10.6 cm before; 11.0 cm after), or CKD stage (3.1 before and after). Two bypass grafts occluded, one at 5 days and the other at 18 months. One of these patients needed HD, but both eventuated in renal transplant at 8 and 34 months, respectively. Three other grafts needed four endovascular interventions for stenosis at 5, 13, 16, and 17 months after operation. Primary patency was 82% at 5 years. Overall and HD-free survival was 85% at 5 years.Conclusions: ORR for stent failure can be done safely, is durable, requires few late interventions, and has excellent freedom from HD. Patients may gain some improvement in hypertension but have little change in renal function.