Safety and efficacy of transaortic renal endarterectomy as an adjunct to aortic surgery.
OBJECTIVE
A study was undertaken to assess the safety and efficacy of transaortic endarterectomy for orificial atherosclerotic renovascular disease (ASRD), particularly in conjunction with surgery for concomitant aortic disease.


METHODS
Forty-three consecutive patients with ASRD treated with transaortic orificial eversion endarterectomy were studied retrospectively to identify surgical indications, technical features, operative morbidity and mortality rates, and efficacy.


RESULTS
A total of 76 renal arteries underwent transaortic endarterectomy for hypertension (88% of patients) or serum creatinine of 1.5 mg/dl or greater (65% of patients), including two patients undergoing dialysis. Concomitant aortic surgery was performed in 39 patients for aneurysmal (n = 30) or occlusive (n = 9) disease. Two (2.6%) of 76 renal endarterectomies required intraoperative conversion to bypass because of poor flow, and three arteries (3.9%) were reimplanted or bypassed because of fragility of the renal orifice after endarterectomy. Thirty-day operative death occurred in two patients (4.7%), and major morbidity occurred in six (14.0%). Hypertension was cured or improved in 83% of patients with hypertension. Among patients with preoperative renal insufficiency, function was improved in 19%, with dialysis discontinued in one of two patients receiving dialysis, and function was worse in 23%, with one patient dependent on dialysis.


CONCLUSIONS
Transaortic renal endarterectomy is an acceptably safe and effective adjunctive technique in selected patients with combined aortic disease and ASRD.
Clair
D G
DG
Department of Surgery, Malcolm Grow Medical Center, Andrews AFB, Md., USA.
Belkin
M
M
Whittemore
A D
AD
Mannick
J A
JA
Donaldson
M C
MC
D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications / Q000601:surgery; D001161:Arteriosclerosis / Q000601:surgery*; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012077:Renal Artery / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies