title: Renal artery repair: consequence of operative failures.
abstract: OBJECTIVE
  This report examines the blood pressure and renal function response in 20 consecutive patients after secondary renal revascularization following failed operative repair.
  
  
  BACKGROUND
  Most reports describing operative failure of renal artery (RA) repair emphasize the technical aspects of redo RA reconstruction and the immediate blood-pressure response to secondary operation. This report examines the eventual renal function and estimated survival after secondary intervention.
  
  
  METHODS
  Primary methods of RA reconstruction, primary blood pressure and renal function responses, and causes of failed RA repair were defined for 20 patients requiring reoperation for recurrent hypertension or renal insufficiency. These parameters were compared with secondary procedures and eventual blood pressure and renal function response. The eventual outcome for these 20 patients was compared with 514 patients managed by primary renal revascularization during the same period.
  
  
  RESULTS
  Failure of primary RA repair correlated with complex fibromuscular dysplasia requiring branch ex vivo reconstruction (p = 0.020). RA thrombosis frequently required nephrectomy (83%), whereas RA stenosis was successfully reconstructed (91 %; p = 0.001). Primary and secondary blood-pressure responses were equivalent (94% vs. 95% cured or improved); however, primary and eventual renal function responses differed significantly (p = 0.015), with seven patients dialysis-dependent on follow-up. Eventual dialysis dependence was associated with preoperative azotemia (p = 0.022), bilateral failure of primary RA repair (p = 0.007), and an increased risk of follow-up death (p = 0.002). Considering all 534 patients, failed RA repair demonstrated a significant and independent association with eventual dialysis dependence and decreased dialysis-free survival.
  
  
  CONCLUSIONS
  Contemporary rates of reoperation after surgical RA repair are low. In properly selected patients, beneficial blood-pressure response is reliably observed after both primary and secondary operative procedures. However, secondary procedures are associated with a significant and independent risk of eventual dialysis dependence.
authors.affiliation: Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-10958, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Hansen
authors.forename: J S
authors.initials: JS
authors.lastname: Deitch
authors.forename: T C
authors.initials: TC
authors.lastname: Oskin
authors.forename: J
authors.initials: J
authors.lastname: Ligush
authors.forename: T E
authors.initials: TE
authors.lastname: Craven
authors.forename: R H
authors.initials: RH
authors.lastname: Dean
mesh_terms: D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000601:surgery*; D001794:Blood Pressure; D002648:Child; D004691:Endarterectomy; D005260:Female; D005352:Fibromuscular Dysplasia / Q000601:surgery*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012077:Renal Artery / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000601:surgery*; D006435:Renal Dialysis; D012086:Reoperation; D017211:Treatment Failure