Surgery for renovascular diseases: a single-center experience in revascularizing renal artery stenosis and aneurysm.
OBJECTIVE
Diagnosis and management of renovascular diseases (RVD) at Hokkaido University Hospital was reviewed with particular emphasis on surgical revascularization (SR).


METHODS
We studied a total of 33 patients with RVD [16 patients with renal artery stenosis (RAS): group 1, and 17 patients with renal artery aneurysm (RAA): group 2, 10 males, 23 females, aged 9-69 years (median 46), unilateral 24, bilateral 9]. Functional diagnosis of RVD with regard to renovascular hypertension (RVH) was done with the captopril test (CP-T) and captopril-enhanced (99m)Tc-DTPA (diethylenetriamine-pentaacetic acid) renal scintigraphy (CER). All were subjected to SR. Number, length, size and site of RVD with involvement of branch arteries dictated the choice of operative method but basically in situ repair for main trunk disease (11 kidneys) and ex vivo bench repair with autotransplantation for those beyond the first bifurcation intrarenally involving branched arteries (24 kidneys) were employed. The outcome was analyzed as to blood pressure control, split renal function, and branch renal artery patency.


RESULTS
(1) Sensitivity of CP-T and CER was 79 and 77% respectively in group 1, while it was 40 and 38% respectively in group 2. (2) Blood pressure was cured in 66.7% (group 1, 68.8% and group 2, 63.6%) and improved in 22.2% (group 1, 18.8% and group 2, 27.3%) with an overall success rate of 88.9%. (3) Renal function was good in 81.3% (group 1, 83.3% and group 2, 78.6%) and fair in 9.4% (group 1, 0% and group 2, 21.4%) with overall success in 90.7%. (4) Patency was preserved in 90.5% of branch anastomoses.


CONCLUSIONS
Despite challenging complexities, SR of RVD is feasible with a reasonable amount of morbidity and effective in controlling blood pressure and preserving renal function in the majority of cases.
Koyanagi
Tomohiko
T
Department of Urology, Hokkaido University Hospital, Sapporo, Japan. tomohiko@med.hokudai.ac.jp
Nonomura
Katsuya
K
Takeuchi
Ichiro
I
Watarai
Yoshihiko
Y
Seki
Toshimori
T
Kakizaki
Hidehiro
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000175:diagnosis* / Q000601:surgery*; D000792:Angiography / Q000379:methods; D002216:Captopril; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging / Q000379:methods; D012077:Renal Artery; D012078:Renal Artery Obstruction / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D016284:Technetium Tc 99m Pentetate; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods*
D002216:Captopril; D016284:Technetium Tc 99m Pentetate