SAFETY AND EFFICACY OF TRANSAORTIC RENAL ENDARTERECTOMY AS AN ADJUNCTTO AORTIC-SURGERY

Purpose: A study was undertaken to assess the safety and efficacy of t ransaortic endarterectomy for orificial atherosclerotic renovascular d isease (ASRD), particularly in conjunction with surgery for concomitan t aortic disease. Methods: Forty-three consecutive patients with ASRD treated with transaortic orificial eversion endarterectomy were studie d retrospectively to identify surgical indications, technical features , operative morbidity and mortality rates, and efficacy. Results: A to tal of 76 renal arteries underwent transaortic endarterectomy for hype rtension (88% of patients) or serum creatinine of 1.5 mg/dl or greater (65% of patients), including two patients undergoing dialysis. Concom itant aortic surgery was performed in 39 patients for aneurysmal (n = 30) or occlusive (n = 9) disease. Two (2.6%) of 76 renal endarterectom ies required intraoperative conversion to bypass because of poor flow, and three arteries (3.9%) were reimplanted or bypassed because of fra gility of the renal orifice after endarterectomy. Thirty-day operative death occurred in two patients (4.7%), and major morbidity occurred i n six (14.0%). Hypertension was cured or improved in 83% of patients w ith hypertension. Among patients with preoperative renal insufficiency , function was improved in 19%, with dialysis discontinued in one of t wo patients receiving dialysis, and function was worse in 23%, with on e patient dependent on dialysis. Conclusion: Transaortic renal endarte rectomy is an acceptably safe and effective adjunctive technique in se lected patients with combined aortic disease and ASRD.