THE OCCLUDED RENAL-ARTERY - AN ONGOING SURGICAL CHALLENGE

Nephrectomy and revascularization are currently the preferred options in the management of the chronically occluded renal artery in patients with renovascular hypertension or renal insufficiency. We review our experience with these two options including early and late functional outcome. Between December 1982 and August 1993, chronic occlusion of t he main renal artery was documented in 30 patients. Patients were cate gorized with respect to surgical intervention: group I underwent nephr ectomy (on the occluded side) plus contralateral revascularization and group II underwent revascularization of the occluded renal artery. Th e median age at the time of operative intervention was 63 years; 53% o f the patients were women and 47% were men. Hypertension was poorly co ntrolled (greater than or equal to 3 medications) in 19 patients, and the preoperative serum creatinine level was >1.8 mg/dl in 24 patients (mean 2.6 +/- 1.4 mg/dl). There were 16 patients in group I and 14 pat ients in group II, and there were no perioperative deaths. Estimated g lomerular filtration rate (greater than or equal to 7 days after opera tion) was either unchanged or improved in 15 of 16 patients in group I and in 13 of 14 in group II, one of whom became dialysis dependent. F ollow-up data were available for 25 of 30 (83%) patients (mean 45 mont hs; range 1 to 108 months). Excluding one early failure, 10 of 13 pati ents in group I and 7 of 11 in group II did not have end-stage renal d isease at last follow-up. Overall, hypertension was cured or improved in 16 of 21 patients. Revascularization as the preferred method of tre atment of the occluded renal artery offers the prospect of renal salva ge. Nonetheless, in the majority of properly selected patients, adequa te renal function may be sustained and satisfactory blood pressure con trol achieved after nephrectomy with contralateral revascularization.