Atheroembolic renal disease: Effect on morbidity and survival after revascularization for atherosclerotic renal artery stenosis

Purpose: Atheroembolic renal disease is increasingly found in older patient s with general atherosclerosis, We evaluated the impact of atheroembolic re nal disease on morbidity and survival after surgical revascularization for atherosclerotic renal artery stenosis. Materials and Methods: The study group comprised 44 patients who underwent surgical revascularization for atherosclerotic renal artery stenosis and co ncomitant intraoperative renal biopsy. Renal biopsy specimens were reviewed by a pathologist and evaluated for the presence or absence of atheroemboli , and the presence and severity of arteriolar nephrosclerosis. Postoperativ e patient data were reviewed to evaluate survival, and the incidence of ren al and systemic morbid events. Patients were followed for 1 to 14.5 years ( median 6.2) after surgical revascularization. Results: Atheroembolic renal disease was identified in the intraoperative b iopsy specimen in 16 patients (36%, group 1) and was absent in 28 (64%, gro up 2), termed groups 1 and 2. Atheroembolic renal disease correlated signif icantly with decreased patient survival. The 5-year survival in groups 1 an d 2 was 54 and 85%, respectively (p = 0.011). Similarly the incidence of sy stemic atherosclerotic complications was significantly higher in group 1 th an group 2 (86 versus 58%, p < 0.05). In addition, renal or renovascular co mplications developed in more group 1 than group 2 patients (p = 0.07). The re was no significant association between the presence or severity of arter iolar nephrosclerosis and postoperative survival or morbid events. Conclusions: Our results indicate that atheroembolic renal disease is assoc iated with decreased survival and an increased incidence of atherosclerotic morbid events after surgical revascularization for atherosclerotic renal a rtery stenosis. This information may be useful for therapeutic decision mak ing in patients with atherosclerotic renal artery stenosis.