title: Hybrid laparoscopic technique for renal artery Takayasu arteritis.
abstract: OBJECTIVE
  To evaluate the feasibility of combined laparoscopic technique for different types of vascular reconstruction in the treatment of Takayasu renal artery stenosis.
  
  
  METHODS
  Retrospective study of seven cases of renal artery stenosis caused by Takayasu arteritis (TA).
  
  
  METHODS
  Institutional practice and hospitalised patients. All these patients manifested renal arterial hypertension and failed to percutaneous transluminal angioplasty (PTA) treatment. Different types of revascularisation using hybrid laparoscopic technique were applied.
  
  
  METHODS
  Laparoscopic renal artery isolation and kidney mobilisation were first performed. Several types of vascular reconstruction were performed as two patients underwent autotransplantation, four patients aortorenal bypass and one splenorenal bypass. For bypass patients, hypogastric artery was harvested by laparoscopic approach while saphenous vein and spleen artery were dissected by conventional opening. Autotransplantation and arterial anastomosis were then performed through an open incision.
  
  
  RESULTS
  All procedures were performed successfully without major intraoperative complications. The total operative time was 191 (130-280) min while laparoscopic part was 62 (40-105) min. The mean blood loss was 261 (150-400) ml. Postoperative blood pressure returned to normal in five patients but two others required single-agent antihypertensive medication. Minor complications included lumbar artery injury and flank pain each in one case. The anastomosis was patent in all patients and no re-stenosis occurred during 6-40 months of follow-up.
  
  
  CONCLUSIONS
  Hybrid laparoscopic techniques involving renal artery dissection and hypogastric artery harvesting are feasible in surgical treatment of Takayasu renal arteritis. This hybrid surgical technique provides an alternative approach to revascularise the renal circulation, especially for the patients of PTA treatment failure.
authors: Department of Urology, The First Affiliated Hospital of Nanjing Medical University, China.
authors: P
authors: P
authors: Shao
authors: C
authors: C
authors: Qin
authors: X
authors: X
authors: Meng
authors: J
authors: J
authors: Li
authors: X
authors: X
authors: Ju
authors: P
authors: P
authors: Li
authors: C
authors: C
authors: Yin
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D000792:Angiography; D017130:Angioplasty; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery; D001158:Arteries / Q000637:transplantation; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000000981:diagnostic imaging / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D013164:Splenorenal Shunt, Surgical; D015607:Stents; D013625:Takayasu Arteritis / Q000000981:diagnostic imaging / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D055815:Young Adult