Simultaneous aortic reconstruction and bilateral renal revascularization

Abstract

Between 1982 and 1987, 32 patients with severe aortorenal atherosclerosis had simultaneous aortic and bilateral renal revascularization. All patients were hypertensive. Eighteen patients (56%) had renal insufficiency with a mean serum creatinine (SC) of 2.8 mg/dl. Nine patients had an aortic aneurysm; the remaining 23 patients had aortoiliac occlusive disease of varying severity. Aortic reconstruction Was done with either a straight (six patients) or bifurcated (26 patients) Dacron graft. Renal revascularization was accomplished with either bypass (60 arteries) or transaortic endarterectomy (four arteries). One patient died of pulmonary embolism (operative mortality rate 3%). Beneficial blood pressure response was achieved in 28 of 31 survivors, (90%). Among the 18 patients with renal insufficiency, mean SC was 2.80 + 1.18 mg/dl preoperatively and 1.65 _+ 0.48 mg/dl postoperatively (p < 0.001). Among eight patients with severe renal dysfunction before surgery (SC greater than 3 mg/dl), mean SC was 3.90-+ 0.85 mg/dl before and 1.79-+ 0.69 mg/dl after operation (p < 0.001). In follow-up extending to 58 months (mean 27.6 months), five late deaths occurred; cumulative survival was 94% at 2 years and 60% at 4 years. There were no instances of worsening hypertension; one patient had deteriorating renal fimction. These results indicate that severe aortorenal atherosclerosis can be managed with simultaneous aortic reconstruction and bilateral renal revascularization at low operative risk. In addition, there can be high expectation of significant and persisting benefit in both hypertension and renal dysfunction after operation.

Simultaneous aortic and renal artery reconstruction: Evolution of an eighteen-year experience

“…In our unit, patients with hypertension or renal insufficiency admitted for aortic surgery and in whom significant renovascular lesions are discovered undergo combined repair. In circumstances where the renal artery lesion is clinically silent, combined operation may be SReferences 6,8,11,18,[20][21][22][23][24][25][26][27] selected after consideration of the patient's overall risk profile. After such consideration, current practice in our unit is consistent with that recently advocated by others in favor of prophylactic renal artery repair for high-grade lesions because the current safety and results of surgery compare favorably with the available natural history data relative to high-grade renal artery stenoses.4,5,7,9 Ultimately, prospective randomized studies will be needed to clarify the role of renal artery reconstruction in this clinical setting.…”