Ten years experience with reconstruction of the chronic totally occluded renal artery

G. Torsello, Z. Szabo, B. Kutkuhn, H. Kniemeyer, W. Sandmann

Research output: Contribution to journalArticlepeer-review

Abstract

The criteria for selection of patients who may benefit from reconstruction of totally occluded renal arteries are not well defined. Of those patients who underwent renal artery reconstruction for renal artery occlusive disease at our institution 13% (52/397) had a chronic renal artery occlusion at preoperative arteriography. In 38 cases (73%) the contralateral renal artery had a significant (>70%) stenosis, which was reconstructed simultaneously. Renovascular hypertension alone (n = 27;52%) or in combination with impaired renal function (n = 25;48%) was the indication for surgical treatment and transaortic thromboendarterectomy was the preferred method of reconstruction (n = 38;73%). Operative mortality was 5.7% and during fallow-up (38 ± 31 months) 4 patients died from myocardial infarction (n = 2), aortic dissection (n = 1) or cerebral haemorrhage (n = 1). Postoperatively 20 patients (44.5%) had a normal blood pressure; in a further 20 (44.5%) the hypertension was easier to control and medication could be reduced. Five patients (11%) remained hypertensive. Postoperative arteriography showed a normal patent renal artery in 40 cases (89%). Postoperative plasma creatinine levels ranged from 0.8 to 3.4 mg% (1.32 ± 0.74) which was a significant reduction from preoperative levels. Two patients with severe uraemia improved to an extent where haemodialysis could be discontinued. Radionuclide scan and the measurements of plasma renin activity before and after administration of a converting enzyme inhibitor (Captopril) were the most reliable diagnostic methods for preoperative patient selection and postoperative follow-up. Kidneys with a Hippuran clearance of 20% or less are not likely to regain useful function even after successful revascularisation.

Original languageEnglish (US)
Pages (from-to)327-333
Number of pages7
JournalEuropean journal of vascular surgery
Volume1
Issue number5
DOIs
StatePublished - Oct 1987
Externally publishedYes

Keywords

  • Kidney function
  • Kidney perfusion
  • Radionuclide studies
  • Renal artery occlusion
  • Renal artery stenosis
  • Renin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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