RENAL-ARTERY REPAIR - CONSEQUENCE OF OPERATIVE FAILURES

Objective This report examines the blood pressure and renal function r esponse in 20 consecutive patients after secondary renal revasculariza tion following failed operative repair. Summary Background Data Most r eports describing operative failure of renal artery (RA) repair emphas ize the technical aspects of redo RA reconstruction and the immediate blood-pressure response to secondary operation. This report examines t he eventual renal function and estimated survival after secondary inte rvention. Methods Primary methods of RA reconstruction, primary blood pressure and renal function responses, and causes of failed RA repair were defined for 20 patients requiring reoperation for recurrent hyper tension or renal insufficiency. These parameters were compared with se condary procedures and eventual blood pressure and renal function resp onse. The eventual outcome for these 20 patients was compared with 514 patients managed by primary renal revascularization during the same p eriod. Results Failure of primary RA repair correlated with complex fi bromuscular dysplasia requiring branch ex vivo reconstruction (p = 0.0 20). RA thrombosis frequently required nephrectomy (83%), whereas RA s tenosis was successfully reconstructed (91%; p = 0.001). Primary and s econdary blood-pressure responses were equivalent (94% vs. 95% cured o r improved); however, primary and eventual renal function responses di ffered significantly (p = 0.015), with seven patients dialysis-depende nt on follow-up. Eventual dialysis dependence was associated with preo perative azotemia (p = 0.022), bilateral failure of primary RA repair (p = 0.007), and an increased risk of follow-up death (p = 0.002). Con sidering all 534 patients, failed RA repair demonstrated a significant and independent association with eventual dialysis dependence and dec reased dialysis-free survival. Conclusions Contemporary rates of reope ration after surgical RA repair are low. In properly selected patients , beneficial blood-pressure response is reliably observed after both p rimary and secondary operative procedures. However, secondary procedur es are associated with a significant and independent risk of eventual dialysis dependence.