Long-term results after surgical reconstruction for renal artery fibromuscular dysplasia

Objectives: to study the initial and long-term results of surgery for renal artery fibromuscular dysplasia ((RFMD). Patients and Methods: all patients undergoing renal artery reconstruction ( RAX) performed for RFMD between January 1980 and December 1997, were studie d. The preprocedural and postprocedural clinical records of 101 patients (8 0 women, 21 men; mean age at surgery 43 years) were retrospectively reviewe d. All surviving patients were invited fbr clinical reexamination and colou r-coded duplex-ultrasound of the renal arteries (RA). Results: initial technical success was achieved in 83 of 93 patients (89%), in whom postoperative angiography (90) or renal scintigraphy (three) were performed for assessment of RAX. Early occlusion (four) or stenosis tone) d emanded reoperation in five patients (5%). The 30-day mortality and morbidi ty were 2% and 12% for the entire group. Primary patency rate tons 74% at 5 years, Fifteen patients had to be reoperated for restenosis after a mean t ime of 33 months, resulting in a secondary patency rate of 85% after 5 year s. In 61 patients with patent RAX at the time of re-examination, arterial h ypertension was cured only in 22 (36%) and improvement in 19 (31%). Conclusion: vascular surgery for RFMD yields good long-term results as to k idney perfusion and function. Surveillance of RAR-patency by means of ultra sound examination is mandatory in case of recurrence of arterial hypertensi on or deterioration. Rates of dire of hypertension are disappointing.