PROPHYLACTIC REPAIR OF RENAL-ARTERY STENOSIS IS NOT JUSTIFIED IN PATIENTS WHO REQUIRE INFRARENAL AORTIC RECONSTRUCTION

Purpose: Simultaneous prophylactic repair of asymptomatic renal artery stenosis (ARAS) in patients who require infrarenal aortoiliac reconst ruction is controversial. This study documents the natural history of ARAS in patients who require aortic reconstruction. Methods: Two hundr ed patients who required aortic reconstruction from 1985 to 1990 for i ndications other than hypertension or renal salvage were identified. A RAS was not repaired. Preoperative angiograms were available for 171 o f 200 patients and were reviewed for renal artery stenosis. Patients w ere assessed for atherosclerotic risk factors, survival, preoperative and follow-up blood pressure, serum creatinine level, antihypertensive medication usage, and need for dialysis. Results: The mean duration o f follow-up was 6.3 years. Twenty-four of 171 patients (14%) had preop erative unilateral 70% to 99% diameter reduction ARAS, and eight (5%) had bilateral 70% to 99% ARAS. Clinical features associated with great er than or equal to 70% ARAS included coronary artery disease, increas ed age, and a diagnosis of hypertension (p < 0.05). Patients with grea ter than or equal to 70% ARAS did not have a decreased 7-year survival rate (66% vs 84%; p = 0.10) but had higher systolic blood pressures ( 153 +/- 25 vs 138 +/- 30 mm Hg; p < 0.05) as well as increased numbers of antihypertensive medications at follow-up (1.1 +/- 0.2 vs 0.7 +/- 1; p < 0.05). The mean serum creatinine level (1.1 +/- 0.3 preoperativ e vs 1.4 +/- 0.8 mg/dl; p = NS) was not increased. One patient (0.58%) with polycystic kidney disease and minimal renal artery stenosis requ ired dialysis. Conclusions: High-grade ARAS in patients who are underg oing infrarenal aortic reconstruction is associated at late follow-up with increased systolic blood pressure and a need for increased number s of antihypertensive medications, but not decreased survival rate, di alysis dependence, or an increase in serum creatinine level. These dat a do not support renal artery repair in patients with ARAS who undergo infrarenal aortic reconstruction.