Long-term results of renal artery reconstruction with autogenous artery in patients with renovascular hypertension.
Renal artery reconstruction for the treatment of renovascular hypertension is preferably performed with an autologous graft when a graft is required. Although satisfactory results with vein grafts have been reported, stenosis and dilatation are not infrequent complications which have been observed only occasionally in arterial grafts. We have analysed our long-term results obtained with autogenous arterial grafts for renal artery reconstruction to determine the functional and anatomical results with regard to these complications. The data from 57 survivors operated on from 1959 through 1983 were analysed. All patients were hypertensive and the average systolic and diastolic blood pressure was 173/109 mmHg (mean number of 2.2 drugs). The renal artery stenosis was caused by arteriosclerosis and fibrodysplasia in 24 and 33 patients, respectively. In situ repair was performed in 30 patients (arterial bypass: 17 patients; splenorenal bypass: 13 patients). Extracorporeal repair of fibrodysplastic branch lesions was performed in 27 patients using branched hypogastric artery grafts (mean number of 2.4 branch anastomoses per kidney). Results were evaluated in the short (mean 8.3 months) and long term (mean 7.5 years) and the blood pressure response classified as either beneficial (cured/improved) or failed. Anatomical results were evaluated by angiography in the short-term in 87% of the patients and the long-term in 70%. A beneficial blood pressure response was obtained in 77% and 86% of patients in the short and long-term, respectively. The average blood pressure level after an interval of several years (long term) was 144/87 mmHg (mean number of 0.9 antihypertensive drugs). After in situ reconstruction, 2 and 1 anatomical failures were observed in the short and long-term, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
van Bockel
J H
JH
Department of Surgery, University Hospital Leiden, The Netherlands.
van Schilfgaarde
R
R
van Brummelen
P
P
Terpstra
J L
JL
D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001158:Arteries / Q000637:transplantation*; D001161:Arteriosclerosis / Q000601:surgery*; D001794:Blood Pressure; D005352:Fibromuscular Dysplasia / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000601:surgery*; D008866:Microsurgery; D009392:Nephrectomy; D011183:Postoperative Complications / Q000209:etiology; D012077:Renal Artery / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000601:surgery*; D013164:Splenorenal Shunt, Surgical; D016042:Transplantation, Heterotopic