RENAL AUTOTRANSPLANTATION FOR RENOVASCULAR HYPERTENSION CAUSED BY MIDAORTIC SYNDROME

Midaortic syndrome (MAS) is a well-recognized but rare cause of renova scular hypertension (RVH). Several techniques have been described to t reat RVH caused by MAS. The authors recently treated two children with MAS and RVH. In both patients the right kidney had two renal arteries . A 13-year-old boy presented with severe headaches, pain in his lower extremities with exertion, and marked hypertension (blood pressure, 1 70/110). An aortogram demonstrated 70% narrowing of his abdominal aort a from the suprarenal region to 5 cm above the iliac bifurcation. Ther e was significant stenosis of the celiac axis, superior mesenteric art ery, and left renal artery. The right kidney had two renal arteries, a nd the upper pale artery was stenotic at its origin. A 10-year-old gir l, known to have hypertension for several years had an aortogram that demonstrated 70% narrowing of the abdominal aorta from the suprarenal region to 3 cm above the iliac bifurcation. There was involvement of t he left renal artery at its orifice. She also had two renal arteries t o the right kidney with the right upper pole artery being stenotic at its origin and in the mid-portion of the vessel. Aortic reconstruction was accomplished with a palytetrafluoroehtylene (PTFE) bypass graft i n each case. The first case also involved patch angioplasty of the cel iac axis. In both cases, the right kidney was autotransplanted. It was removed intraoperatively, cold perfused, and the two renal arteries r econstructed followed by transplantation to the right iliac vessels. I n both cases the left renal artery was reimplanted into the PTFE graft . Both patients had uncomplicated postoperative courses. The 13-year-o ld boy had evidence of renal ischemia in a portion of the lower pole o f the autotransplanted kidney by DTPA scan. He has mild hypertension c ontrolled with antihypertensive medication. The 10-year-old girl has a normal DTPA scan and is normotensive. MAS is a rare and challenging c ongenital vascular anomaly that causes RVH. In the presence of double renal arteries the technique of autotransplantation with cold perfusio n and ''bench'' vascular reconstruction reduces the warm ischemia time and should produce satisfactory results. Copyright (C) 1997 by W.B. S aunders Company.