Influence of preoperative risk factors and the surgical procedure on surgical mortality in renovascular hypertension.
The present study was undertaken to assess surgical risk in 112 severely hypertensive patients with renovascular disease secondary to atherosclerosis. The influence of preoperative risk factors and the surgical procedure on surgical mortality was also investigated. Extrarenal atherosclerosis was present in 51 percent of the patients, and hypertensive target organ damage was present in 66 percent. Renal artery reconstruction was performed unilaterally in 92 patients and bilaterally in 20 patients. Simultaneous aortoiliac operations were performed in 25 patients. There were nine operative deaths (8 percent). The presence of extrarenal atherosclerosis was particularly associated with mortality (14 percent compared with 1.8 percent when it was absent; p = 0.02). The surgical procedure also represented a significant risk; the mortality rate was 1.4 percent if surgery was restricted to unilateral reconstruction, but otherwise it increased to 20 percent (p = 0.001). This increase in mortality rate was clearly associated with aortoiliac surgery (20 percent compared with 4.6 percent when aortoiliac surgery was not performed; p = 0.025) and could be explained by the increased blood loss during operation. We conclude that the surgical treatment of renovascular disease secondary to atherosclerosis can be safely performed, provided that extrarenal atherosclerosis is absent and that simultaneous aortoiliac surgery can be avoided.
van Bockel
J H
JH
Department of Surgery, University Hospital Leiden, The Netherlands.
van Schilfgaarde
R
R
Felthuis
W
W
Hermans
J
J
Terpstra
J L
JL
D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000150:complications / Q000401:mortality / Q000601:surgery; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D007431:Intraoperative Complications / Q000401:mortality; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012077:Renal Artery / Q000601:surgery; D012307:Risk Factors