Bilaterial renal artery atherosclerosis--the results of surgical treatment.
OBJECTIVE
To assess the outcome of surgical treatment for severe bilateral renal artery stenosis.


METHODS
Non-randomised, prospective, consecutive series.


METHODS
Twenty-five patients undergoing surgical reconstruction of whom 14 required aortic replacement (aneurysm, n = 7, severe claudication, n = 7). In 22 patients, the principle aim of treatment was preservation or salvage of renal function whilst three patients had intractable hypertension.


METHODS
Serum creatinine and blood pressure were measured at the most recent follow-up (minimum 6 months, median 17 months) and compared to preoperative values.


RESULTS
Renal function (serum creatinine) improved or stabilised in 16 of 18 patients in whom it was elevated preoperatively (>140 mumol/l; 3 patients on dialysis) whilst one patient with early graft occlusion subsequently required long term dialysis. Blood pressure control was also improved in 14 patients. There were four postoperative deaths (16%) and five patients required re-exploration for postoperative anuria (3) or bleeding (2).


CONCLUSIONS
Surgical revascularisation preserves renal function and may improve blood pressure control in patients with advanced multi-system atherosclerosis. The operative morbidity and mortality is significant although historical data suggests that this is less than for similar patients treated medically.
Crinnion
J N
JN
Vascular Surgical Unit, The General Infirmary at Leeds, Yorkshire, U.K.
Gough
M J
MJ
D000368:Aged; D001161:Arteriosclerosis / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012078:Renal Artery Obstruction / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D018709:Statistics, Nonparametric; D014463:Ultrasonography
D003404:Creatinine