Purpose: The durability of renal preservation after surgical intervent
ion has not been well defined, particularly in patients with associate
d aortic disease. A review of all patients at the Emery University Hos
pital with renal insufficiency (creatinine level equal to or greater t
han 1.8) and concomitant atherosclerotic aortic and renovascular disea
se was undertaken. Methods: Fifty patients underwent both renal revasc
ularization (71 kidneys) and the repair of aneurysmal or symptomatic a
ortic occlusive disease between 1982 and 1992. Hypertension was presen
t in 96% of patients and diabetes was present in 10%. The preoperative
estimated glomerular filtration rate (EGFR) was 25.18 +/- 8.29 ml/min
(creatinine level 3.1 +/- 1.5 mg/dl). Operative management included b
ilateral renal artery repair (n = 21), unilateral repair alone (n = 17
), and unilateral repair with contralateral nephrectomy (n = 12). The
relative percent change in the postoperative EGPR (equal to or greater
than 7 days after operation) increased by at least 20% in 42% of the
patients, had decreased by 20% or more in only 4%, and was otherwise c
ategorized as unchanged in the remaining 54% of the study group. Resul
ts: The 30-day operative mortality rate was 2.0% (1 of 50). Forty-five
of the surviving 49 patients (98.8%) were available for follow-up (me
dian 49 months). During this period nine patients (18.4%) eventually r
equired dialysis, four within 6 months of operation, and 19 patients d
ied. Neither subgroup experienced a retrieval of renal function after
operation. Five-year survival rate was 61%, and a trend was noted betw
een the risk of death and the relative change in EGPR after operation
(p = 0.13). The likelihood of eventually requiring long-term dialysis
was highest among those patients with low preoperative functional rena
l reserve as measured by preoperative creatinine level of 3 mg/dl or g
reater (p < 0.0001), or preoperative EGPR less than 20 ml/min (p = 0.0
001). Blood pressure was cured or improved in 50% at late follow-up. C
onclusions: Early improvement of renal function may be observed in nea
rly one half of patients subjected to combined aortic and renal revasc
ularization. Nonetheless, renal preservation may not be sustainable in
patients with compromised preoperative function. Intervention before
marked functional decline remains the best option for minimizing the r
isk of eventual dialysis.