title: Long-term effectiveness of extraanatomic renal artery revascularization.
abstract: BACKGROUND
  The efficacy of direct aortorenal bypass and renal artery endarterectomy are well established. The purpose of this study is to define better the results of extraanatomic renal revascularization procedures.
  
  
  METHODS
  From April 1987 to March 1993, 124 patients underwent renal artery revascularization. Forty-eight (39%) of them (33 women, 15 men; average age, 65.9 years) underwent 49 extraanatomic renal artery bypasses. Preoperative risk factors included smoking in 30 patients (61%), history of myocardial infarction in 14 (29%), diabetes mellitus in 11 (22%), congestive heart failure in nine (18%), chronic obstructive pulmonary disease in 11 (22%), and stroke in six (12%). The average creatinine level was 2.3 mg/dl. The average number of antihypertensive medications was 2.4. Thirty iliorenal, 10 gastroduodenal-renal, seven hepatorenal, and two splenorenal bypasses were performed together with 10 contralateral nephrectomies.
  
  
  RESULTS
  Six major postoperative complications occurred. There were no deaths. Forty-one (85%) of patients had improvement or cure of their hypertension. Seven (15%) of patients failed to respond to treatment, and three required subsequent nephrectomy. After operation the average creatinine level was 1.7 mg/dl and the average number of medications was 1.7. Mean follow-up period has been 23.2 months (range, 1 to 79 months).
  
  
  CONCLUSIONS
  Extraanatomic bypass proved to be efficacious in treating hypertension and preserving renal function and has an acceptable rate of morbidity and mortality. We conclude that these procedures are an acceptable alternative to direct aortorenal artery revascularization.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
authors.forename: J M
authors.initials: JM
authors.lastname: Reilly
authors.forename: B G
authors.initials: BG
authors.lastname: Rubin
authors.forename: R W
authors.initials: RW
authors.lastname: Thompson
authors.forename: B T
authors.initials: BT
authors.lastname: Allen
authors.forename: C B
authors.initials: CB
authors.lastname: Anderson
authors.forename: G A
authors.initials: GA
authors.lastname: Sicard
mesh_terms: D000368:Aged; D001161:Arteriosclerosis / Q000150:complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000601:surgery; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012077:Renal Artery / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000209:etiology / Q000601:surgery