COMBINED RENAL-ARTERY STENOSIS AND AORTIC-ANEURYSM - TREATMENT OPTIONS

The purpose of this study was to analyze outcomes of two different tre atment strategies in patients treated for renal artery (RA) stenosis a nd a coincidental abdominal aortic aneurysm (AAA). A total of 50 patie nts were encountered who required treatment for concomitant RA stenosi s and an AAA from 1980 to 1994. Simultaneous operative aortic and RA r econstruction was done in 32 patients, whereas 18 patients were treate d with preoperative percutaneous transluminal renal artery angioplasty (PTRA). The two groups were well matched with respect to age, AAA siz e, incidence of hypertension, preoperative creatinine level, and creat inine clearance (all p values >0.07). Aortorenal bypass (18 RAs), reim plantation (18 RAs), or endarterectomy (2 RAs) was performed to correc t a mean RA stenosis of 88%, whereas 23 RAs (91% mean stenosis) were t reated with preoperative PTRA. PTRA failed in four patients with RA st enosis, and they were successfully treated with surgery (3 bypasses an d 1 reimplantation). Statistical analysis did not demonstrate a signif icant difference between these four failed PTRA patients, the 14 succe ssful PTRA patients, and the 32 RA reconstruction patients in terms of operating time (p = 0.15), operative blood loss (p = 0.20), intensive care unit days (p = 0.71), or total hospital days (p = 0.94). Among t he 40 patients available for follow-up, hypertension was cured in seve n, improved in 10, unchanged in 15, and worse in eight with no differe nce demonstrated between the groups (p = 0.73). These data suggest tha t preoperative PTRA has no specific advantage over surgical RA reconst ruction in patients with concomitant RA stenosis and AAA. Failed PTRA did not preclude or complicate subsequent operative RA revascularizati on.