Reoperation for complications of renal artery reconstructive surgery undertaken for treatment of renovascular hypertension

Abstract

Seventy-two secondary operations for complications of prior renal artery reconstructive surgery were undertaken in 58 patients. This experience evolved from the management of 373 patients who underwent 425 primary operations for renovascular hypertension. Secondary operations were performed 10 times in pediatric patients following 42 primary procedures (24%); 44 times in adult fibrodysplastic patients following 199 initial operations (22%); and 18 times in atherosclerotic patients after 184 primary operations (10%). The overall reoperation rate was 15.5% (58 of 373 patients). Reoperation typically followed persistent or recurrent hypertension caused by graft thromboses, perianastomotic graft narrowing, or progressive nonanastomotic graft stenoses. Aneurysmal deterioration of vein grafts was an uncommon reason for reoperation. Secondary reconstructions included nephrectomy (31), bypass with vein grafts (15) or prosthetic grafts (8), angioplasty or reimplantation (12), thrombectomy (4), and operative dilation (2). Benefits regarding hypertension control were afforded 91% of these patients. One death occurred among the 72 reoperations, representing a 1.4% operative mortality rate. Reoperative renal artery reconstructive surgery for complications of renal revascularization may present formidable technical problems. Early diagnosis and prompt reoperation with exacting vascular surgical techniques are most likely to provide optimal results.

Ex vivo repair of renal artery aneurysms

“…The earliest review of complications of renal artery reconstruction revealed that only 3 (1%) of 278 aortorenal saphenous vein bypass grafts required revision. 16 Another group demonstrated good durability, with no saphenous bypass grafts used for renal artery reconstruction rupturing or requiring revision. 17 In yet another review of 198 renal bypass grafts with saphenous vein, 5 developed dilation (all in children) but remained stable and did not require reoperation during the follow-up period.…”

Saphenous vein graft aneurysm with graft-enteric fistula after renal artery bypass

“…5 Citing vein graft ectasia in 20% of vein grafts, 6 vein graft aneurysms in 6% of adult bypass recipients, and vein graft aneurysms in 20% of pediatric bypass recipients, 7 they considered operative repair of vein graft aneurysms primarily to avoid distal thrombus embolization.…”