USE OF THE SPLENIC AND HEPATIC-ARTERY FOR RENAL REVASCULARIZATION IN PATIENTS WITH ATHEROSCLEROTIC RENAL-ARTERY DISEASE

Hepatorenal and splenorenal bypasses are gaining an increased populari ty as an alternative to renal artery endarterectomy and aortorenal byp ass in selected patients. However, there are few reports of the long-t erm results of this procedure. The purpose of this study was to assess the performance of the hepatic and splenic arterial sources in patien ts with atherosclerotic renal artery disease. We reviewed our 7-year e xperience between 1988-1995. A total of 146 operative renal artery rec onstructions were performed, including 45 hepatorenal and/or splenoren al by-pass in 38 patients, (19 male, 19 female, mean age 62 +/- 12 yea rs) for treatment of renovascular hypertension, renal preservation or both. The mean preoperative creatinine was 2.95 mg/dl (2.11-3.47, 95% confidence limits). The average number of antihypertensive medications was 2.63. There was one postoperative death from myocardial infarctio n and two cases of early graft thrombosis, one of which was treated by thrombectomy reestablishing patency. In two patients with persistent hypertension selective angiography demonstrated high-grade anastomotic stenoses which were successfully dilated by balloon angioplasty. The postoperative mean creatinine decreased to 2.54 mg/dl (1.82-3.27, 95% confidence limits), (p = 0.17) and the average number of antihypertens ive medications decreased to 1.9 (p = 0.001). During the median follow -up of 33 months, 10 patients died, mainly from cardiac causes. Our ex perience indicates that the splenic and hepatic arteries provide usefu l alternatives to renal revascularization in selected circumstances wi th an acceptable rate of perioperative mortality and morbidity. The ex pected long-term survival in this group of patients is low.