Is prosthetic renal artery reconstruction a durable procedure? An analysisof 489 bypass grafts

Objective: Renal artery stenosis has been classically addressed with saphen ous vein bypass graft or transaortic endarterectomy performed either primar ily or in combination with an aortic procedure. In this series, we report t he outcome of our 12-year experience with renal artery reconstruction using prosthetic conduit. Methods: Patients undergoing renal artery bypass grafting from 1987 to 19'9 9 were identified. Demographics, indications, concurrent operations, compli cations, and patency were analyzed. Patients underwent postoperative duplex scan with subsequent ultrasound scans at 6-month intervals. Results: There were 489 procedures performed in 414 patients with indicatio ns: high-grade renal artery stenosis in combination with abdominal aortic a neurysm repair or symptomatic aortoiliac occlusive disease (309 [63%]), ren ovascular hypertension (118 [24%]), and renal salvage (20 [4%]). Indication s for the remainder included trauma, renal artery aneurysm, or an infected aortic graft. Inflow was aorta or aortic graft in 95% of patients with the remainder taken from the iliac or visceral vessels. The retroperitoneal app roach was used in 97.8%. Nonfatal complications occurred in 11.4% with a 1. 4% early and 4.8% late occlusion rate. Renal function worsened in 3.1% of a ll patients. Secondary patency at 1 and 5 years was 98% and 96%, respective ly. Conclusion: Renal artery reconstruction with prosthetic conduit has an acce ptable and durable result whether used for primary renal artery reconstruct ion or concomitant reconstruction with aortic procedures.