Concomitant renal revascularization with aortic surgery: Are the risks of combined procedures justified?

Indications for concomitant renal revascularization during aortic surgery a re not well established. Higher mortality and poorer results are often cite d. To examine this, all combined aortic and renal revascularization procedu res from August 1992 until May 1998 were reviewed. Of 2003 major arterial r econstructions performed on the Vascular Teaching Service, 45 patients (2%) underwent renal revascularization. Of these 31 patients (69%) had combined aortic and renal procedures. Aortic pathology in these 31 patients (54% ma le, 94% white, median age 64 years) included arterial occlusive disease (n = 21; 47%), abdominal aortic aneurysm (n = 6; 13%), and thoracoabdominal ao rtic aneurysm (n = 4; 9%). In all 31 cases the patient presented because of the aortic pathology. Indications for concomitant renal revascularization included renovascular hypertension (n = 21; 68%) and preservation of renal function (n = 10; 32%). Renal revascularization procedures included transao rtic endarterectomy (n = 23; 74%), renal bypass (n = 7; 23%), and both bypa ss and endarterectomy (n = 1; 3%). Seven (22%) complications and two (6%) d eaths (both patients operated on for renal salvage) occurred perioperativel y. Complications included wound infection (n = 2: 6%), postoperative bleedi ng (n = 1; 3%), respiratory failure (n = 1; 3%), deep venous thrombosis (n = 1; 3%), cerebrovascular accident (n = 1; 3%), and pseudomembranous entero colitis (n = 1; 3%). All patients either were cured of their hypertension ( n = 5; 24%) or were improved (n = 16; 76%) at 3 months. No patient to date operated on for renal salvage progressed to chronic hemodialysis, but morta lity was higher after renal revascularization for renal salvage versus hype rtension (20% as. 0; P = 0.034). There was no significant difference in mor tality between the combined aortic/renal procedures versus aortic procedure s alone. Despite adding complexity, renal revascularization in patients und ergoing aortic surgery appears relatively safe and effective. These data fa vor an aggressive approach toward renal revascularization in selected patie nts needing aortic surgery.