Renal failure and advanced atherosclerotic lesions. Salvage by vascular reconstruction.
Occlusive renal artery lesions and progressive renal failure have a dismal prognosis if not treated. We analyzed our results to determine if the risks of renal vascularization were justified based on the final outcome in such patients. Inclusion criteria were a creatinine concentration of at least 160 mumol/L (1.8 mg/dL) and one of the following angiographic findings: (1) severe (greater than or equal to 75%) bilateral occlusions, (2) total occlusion with severe (greater than or equal to 75%) contralateral occlusion, or (3) solitary kidney with severe (greater than or equal to 75%) occlusion. Thirty patients met these criteria and underwent revascularization. Six required simultaneous aortic reconstruction. The average creatinine concentration on admission was 310 mumol/L (3.55 mg/dL); this had a statistically significant improvement to 210 mumol/L (2.41 mg/dL) at discharge. There was one perioperative death (3.3%). Initially, 22 patients had improved function (creatinine concentrations 20% lower), and seven patients had stable creatinine values. Eight patients ultimately required long-term dialysis. In the remaining 21 patients, with an average follow-up of 32 months, the average creatinine concentration was 220 mumol/L (2.51 mg/dL), still a significant improvement. Thus, we have demonstrated the relative safety and benefit of operating on these high-risk patients.
Elmore
J R
JR
Department of Surgery, Maine Medical Center, Portland 04102.
Ray
F S
FS
Dillihunt
R C
RC
Herbert
W E
WE
D001161:Arteriosclerosis / Q000150:complications / Q000601:surgery*; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000378:metabolism / Q000628:therapy; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D012077:Renal Artery / Q000601:surgery*; D006435:Renal Dialysis
D003404:Creatinine