Supraceliac aortorenal bypass.
OBJECTIVE
To determine the efficacy and durability of supraceliac aortorenal bypass grafting for symptomatic atherosclerotic renal artery disease.


METHODS
Retrospective review of a 10-year, single-institution experience.


RESULTS
Seventeen patients underwent 27 bypass procedures (seven unilateral, 10 bilateral) for atherosclerotic renovascular hypertension. The patients' mean age was 62.7 +/- 8.8 years. Diffuse aortoiliac and visceral atherosclerosis was confirmed on arteriogram; most (88%) celiac axis branches and all infrarenal aortas and common iliac arteries were found unsuitable for use as a donor vessel. Twenty-six bypass procedures (96%) were performed with autologous vein grafts. Seventeen bypass procedures (63%) were performed during partial aortic occlusion. There were no operative deaths or early occlusions. Postoperative complications occurred in four patients (24%). The mean duration of follow-up was 28 +/- 19 months (range, 2 to 69 months). By life table analysis, the 5-year primary patency and assisted primary patency rates were 95% and 100%, respectively. The mean systolic blood pressure decreased from 180 +/- 38 mm Hg to 135 +/- 20 mm Hg (p = 0.0003), and the mean diastolic blood pressure decreased from 96 +/- 16 mm Hg to 77 +/- 9 mm Hg (p = 0.0002). The number of antihypertensive medications decreased from 2.8 +/- 1.2 to 1.4 +/- 1.0 (p = 0.002). Significant improvement in serum creatinine level was seen among patients with preoperative renal insufficiency. Hypertension was cured in 29%, improved in 53%, and unchanged in 18%. During late follow-up, only four patients (24%) required subsequent aortic reconstruction.


CONCLUSIONS
Supraceliac aortorenal bypass grafting is a safe and durable alternative for renal artery revascularization. This technique should be considered in patients who have diffuse infrarenal aortoiliac and visceral artery occlusive disease and require renal revascularization procedures.
Hagino
R T
RT
Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9157, USA.
Valentine
R J
RJ
Clagett
G P
GP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000379:methods* / Q000706:statistics & numerical data; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D014463:Ultrasonography; D014654:Vascular Patency