COMBINED AORTIC AND RENAL-ARTERY SURGERY - A CONTEMPORARY EXPERIENCE

Purpose This retrospective study examines results with simultaneous ao rtic and renal artery repair in 133 consecutive hypertensive patients. These results are compared with consecutive patient groups undergoing aortic reconstruction alone (269 patients) or renal artery reconstruc tion alone (182 patients). Methods From January 1987 through July 1995 , 61 women and 72 men (mean age, 62.5 years) underwent combined repair of renal artery and aortic disease (abdominal aortic aneurysm [AAA]: 47 patients; occlusive disease: 86 patients; both: 12 patients). All p atients were hypertensive (mean blood pressure: 194/103 mmHg; mean med ications: 2.4). Evidenced by serum creatinine levels greater than or e qual to 2.0 mg/dL, 46 patients (35%) had significant renal dysfunction (mean serum creatinine level: 3.78 mg/dL; range, 2.0-10.6 mg/dL, incl uding 7 dialysis-dependent patients). Aortic replacements (29% tube gr afts; 71% bifurcated grafts) were combined with unilateral renal arter y repair in 47% of patients; 53% had bilateral repair. Preoperative cl inical features and perioperative mortality were compared with those g roups having isolated aortic and renal repairs. Results There were sev en perioperative deaths (5.3%) after combined repair, which differed s ignificantly from isolated aortic repair (mortality. 0.74%; p = 0.005) , but did not reach statistical significance when compared with the is olated renal artery group (mortality: 1.65%; p = 0.145). Risk analysis did not reveal a significant association between preoperative clinica l features and mortality in either the combined repair group or the gr oups undergoing renal repair alone or aortic repair alone. Among survi vors in the combined group, a favorable hypertension response was obse rved in 63%. This differed significantly from the group receiving rena l repair alone (90% cured/improved; p < 0.001). Based on a 20% decreas e in serum creatinine levels, excretory renal function was improved in 33% of patients with combined repair, including four of the seven pat ients removed from hemodialysis. There were eight late deaths in the c ombined group. Conclusions Our experience suggests that contemporary p erioperative mortality for combined aortic and renal repair has improv ed compared with earlier reports; however, perioperative mortality for simultaneous reconstruction remains greater than repair of aortic dis ease alone. Moreover, a lower rate of favorable hypertension response was observed after combined correction compared with renal artery repa ir alone. These differences suggest that aortic and renal artery repai r should only be combined for clinical indications rather than for pro phylactic repair of clinically silent disease.