CONCOMITANT RENAL ENDARTERECTOMY AND AORTIC RECONSTRUCTION

Purpose: This retrospective study is to determine the efficacy and dur ability of renal endarterectomy in patients undergoing simultaneous ao rtic reconstruction. In addition, the operative risk to patients with symptomatic and asymptomatic renal artery stenosis is evaluated. Metho ds: The results of a retrospective study of 101 patients who underwent combined procedures are presented. All patients demonstrated at least a 75% stenosis of the renal artery ostium by arteriography and underw ent surgical repair of aneurysmal (n = 33) or aortic occlusive (n = 68 ) disease. The indications for renal revascularization were hypertensi on necessitating multiple medications (47%), hypertension combined wit h renal insufficiency (18%), renal insufficiency alone (5%), and asymp tomatic stenosis (30%). Blood pressure and antihypertension medication s were monitored during the follow-up period (mean 3.3 years). Results : The perioperative mortality rate was 1%, with a postoperative morbid ity rate of 15%. The conditions of 74% of patients with hypertension w ere improved or cured, 23% were unchanged, and 3% were worse after sur gery. Systolic and diastolic blood pressure in all patients remained s ignificantly diminished during follow-up visits at 3 months, 6 months, 1 year, 3 years, and 6 years (p < 0.01). There was no significant imp rovement in serum creatinine levels in patients with preexisting renal insufficiency. A small but statistically significant decrease in syst olic blood pressure and serum creatinine level was noted after operati ve intervention in the symptom-free patients (p < 0.005). There were n o deaths in the asymptomatic subgroup, and significant azotemia did no t develop in any of these patients after operation. Conclusions: Renal endarterectomy is an effective and durable method of renal revascular ization. Furthermore, it is a technique that can be safely combined wi th aortic surgery and can be considered in the treatment of high-grade , asymptomatic lesions in patients undergoing aortic reconstruction.