LONG-TERM SURVIVAL AFTER SURGICAL REVASCULARIZATION FOR ATHEROSCLEROTIC RENAL-ARTERY DISEASE

Purpose: We analyzed the long-term clinical outcome and survival after surgical revascularization for atherosclerotic renal artery stenosis. Materials and Methods: The study group comprised 222 patients who und erwent surgical revascularization for atherosclerotic renal artery ste nosis between 1974 and 1987. The indications for performing surgical r evascularization were treatment of hypertension in 60 patients, preser vation of renal function in 12, and control of hypertension and preser vation of renal function in 148. Postoperative blood pressure, renal f unction and survival data were analyzed during a mean followup of 7.4 years. Results: There were 5 operative deaths (2.2%) and postoperative thrombosis or stenosis of the repaired renal artery occurred in 16 pa tients (7.3%). Long-term cure or improvement of renovascular hypertens ion was achieved in 72.4% of patients. Preoperative renal function cor related significantly with a favorable blood pressure response to surg ical revascularization (p = 0.013). Long-term improvement or stabiliza tion of renal function was achieved in 71.3% of patients. Preoperative renal function (p = 0.034) and bilateral atherosclerotic renal artery stenosis (p = 0.04) correlated significantly with a favorable renal f unction result after surgical revascularization. Actuarial 5 and 10-ye ar survivals for the entire series from the time of surgical revascula rization were 81 and 53%, respectively. The expected 5 and 10-year sur vivals for a comparable healthy population are 89 and 77%, respectivel y. Using a multivariate analysis, factors correlating with diminished long-term survival were age older than 60 years (p = 0.002), coronary artery disease (p = 0.031), and previous vascular operations (p = 0.00 1). Conclusions: These data support the long-term therapeutic efficacy of surgical revascularization in patients with atherosclerotic renal artery stenosis. The merits of newer forms of therapy, such as percuta neous transluminal angioplasty and endovascular stenting, must ultimat ely be weighed against these results.