Outcome of renal artery reconstruction - Analysis of 687 procedures

Objective To evaluate the short- and long-term results of surgical reconstr uction of the renal arteries, the authors review their experience with more than 600 reconstructions performed over a 12-year period. Summary Background Data Reconstruction of the renal arteries, whether for p rimary renal indications or concomitantly with aortic reconstruction, has e volved over the past 40 years. There is concern that renal artery reconstru ctions carry significant rates of mortality and morbidity and may fare poor ly compared with less-invasive procedures. Methods From 1986 to 1998, 687 renal artery reconstructions were performed in 568 patients. Of these, 105 patients had simultaneous bilateral renal ar tery reconstructions. Fifty-six percent of the patients were male; 11% had diabetes; 35% admitted to smoking at the time of surgery. Mean age was 67 ( range, 1 to 92). One hundred fifty-six (23%) were primary procedures and th e remainder were adjunctive procedures with aortic reconstructions; 406 wer e abdominal aortic aneurysms and 125 were aortoiliac occlusive disease. Fiv e hundred procedures were bypasses, 108 were endarterectomies, 72 were reim plantation, and 7 were patch angioplasties. There were 31 surgical deaths ( elective and emergent) in the entire group for a mortality rate of 5.5%. Pr edictors of increased risk of death were patients with aortoiliac occlusive disease and patients undergoing bilateral simultaneous renal artery revasc ularization. Cause of death was primarily cardiac. Other nonfatal complicat ions included bleeding (nine patients) and wound infection (three patients) . There were 9 immediate occlusions (1.3%) and 10 late occlusions (1.5%). T hirty-three patients (4.8%) had temporary worsening of their renal function after surgery. Conclusion Renal artery revascularization is a safe and durable procedure. it can be performed in selected patients for primary renovascular pathology , it can also be an adjunct to aortic reconstruction with acceptable mortal ity and morbidity rates.