Late changes in aorto-renal vein transplants.
The results of 152 renal artery reconstructions in 128 hypertensive patients were reviewed 1 to 15 years postoperatively in 89 of 98 survivors. Forty-seven (52.8%) patients were normotensive, 29 (32.6%) are improved, and 13 (14.6%) were not improved. Angiography was performed 1 to 11 years after the operation. Only 2 of the 31 vein implants showed an adequate lumen. Four vein grafts were occluded. In 2 out of 4 stenosed transplants stenosis was functionally significant, and the patients with recurrent hypertension underwent re-reconstruction. The causes of the stenoses were severe constriction by scar tissue and extensive subintimal cellular proliferation of the vein graft. Twelve of 31 vein bypass grafts were dilated by an average of 22%. The average increase in caliber of the remaining 9 vein grafts was 106%. The possible contributory factors were forceful distension, excessive adventitial dissection, inadequate storage of the vein, ischemic damage of the vein wall (especially in younger patients), and the increase flow rate through the transplant.
D000328:Adult; D006801:Humans; D006977:Hypertension, Renal / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011859:Radiography; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging*; D012501:Saphenous Vein / Q000637:transplantation*; D013997:Time Factors; D014182:Transplantation, Autologous