title: Concomitant renal endarterectomy and aortic reconstruction.
abstract: OBJECTIVE
  This retrospective study is to determine the efficacy and durability of renal endarterectomy in patients undergoing simultaneous aortic reconstruction. In addition, the operative risk to patients with symptomatic and asymptomatic renal artery stenosis is evaluated.
  
  
  METHODS
  The results of a retrospective study of 101 patients who underwent combined procedures are presented. All patients demonstrated at least a 75% stenosis of the renal artery ostium by arteriography and underwent surgical repair of aneurysmal (n = 33) or aortic occlusive (n = 68) disease. The indications for renal revascularization were hypertension necessitating multiple medications (47%), hypertension combined with renal insufficiency (18%), renal insufficiency alone (5%), and asymptomatic stenosis (30%). Blood pressure and antihypertension medications were monitored during the follow-up period (mean 3.3 years).
  
  
  RESULTS
  The perioperative mortality rate was 1%, with a postoperative morbidity rate of 15%. The conditions of 74% of patients with hypertension were improved or cured, 23% were unchanged, and 3% were worse after surgery. Systolic and diastolic blood pressure in all patients remained significantly diminished during follow-up visits at 3 months, 6 months, 1 year, 3 years, and 6 years (p < 0.01). There was no significant improvement in serum creatinine levels in patients with preexisting renal insufficiency. A small but statistically significant decrease in systolic blood pressure and serum creatinine level was noted after operative intervention in the symptom-free patients (p < 0.005). There were no deaths in the asymptomatic subgroup, and significant azotemia did not develop in any of these patients after operation.
  
  
  CONCLUSIONS
  Renal endarterectomy is an effective and durable method of renal revascularization. Furthermore, it is a technique that can be safely combined with aortic surgery and can be considered in the treatment of high-grade, asymptomatic lesions in patients undergoing aortic reconstruction.
authors.affiliation: Mobile Infirmary Medical Center, AL.
authors.forename: J W
authors.initials: JW
authors.lastname: McNeil
authors.forename: S T
authors.initials: ST
authors.lastname: String
authors.forename: R B
authors.initials: RB
authors.lastname: Pfeiffer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D001807:Blood Vessel Prosthesis; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality; D012078:Renal Artery Obstruction / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012079:Renal Circulation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D003404:Creatinine