Spontaneous dissection of branch renal artery- is conservative management safe and effective?
OBJECTIVE
We analyzed the long-term results of conservative management for spontaneous branch renal artery dissection.


METHODS
In the last 6 years 8 patients were treated for acute spontaneous branch renal artery dissection at our department. The diagnosis was established by angiography, which showed primary branch artery dissection in all cases. All patients were treated with antihypertensive and platelet anti-aggregate therapy. None of them underwent surgery. After treatment patients were evaluated for blood pressure and renal function and by abdominal computerized tomography angiography with 3-dimensional reconstruction.


RESULTS
Median followup was 72.3 months. In 6 patients blood pressure was controlled with a single antihypertensive agent. In another patient 3 antihypertensive agents were required. The remaining patient continued to have labile hypertension because of poor compliance with treatment. Renal function was normal in 7 patients. Control computerized tomography angiography showed proximal arterial remodeling in 6 patients and persistent occlusion of primary branches in 2.


CONCLUSIONS
In our experience conservative management of spontaneous branch renal artery dissection is safe and effective. Surgical treatment should be proposed at the acute stage only in patients with malignant hypertension or renal failure and at the chronic stage in those with refractory renovascular hypertension.
Misrai
Vincent
V
Department of Vascular Surgery, Hôpital Saint Joseph, Paris, France.
Peyromaure
Michaël
M
Poiree
Sylvain
S
Marteau
Véronique
V
Laurian
Claude
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008875:Middle Aged; D012077:Renal Artery; D012189:Retrospective Studies