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Angioplasty does not affect subsequent operative renal artery revascularization
T R Desai1, S L Meyerson, J F McKinsey
1Section of Vascular Surgery, University of Chicago, Chicago, Ill. 60637, USA.
Surgery
|October 3, 2000
Summary
Surgical repair of renal artery stenosis is effective, even after failed angioplasty. Outcomes for patients undergoing secondary reconstruction after renal artery angioplasty or stenting are comparable to primary surgical repair.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Nephrology
Background:
- Percutaneous renal artery angioplasty and stenting are increasingly used for renal revascularization.
- Established patient outcomes after failed angioplasty are lacking.
Purpose of the Study:
- To evaluate surgical outcomes in patients with renal artery stenosis who underwent either primary surgical repair or secondary reconstruction after failed angioplasty/stenting.
Main Methods:
- Retrospective review of 31 patients (38 arteries) undergoing renal artery revascularization between 1993-1999.
- 20 patients had primary surgical repair; 11 had secondary reconstruction after angioplasty (n=7) or angioplasty with stenting (n=4).
- All patients presented with severe hypertension and some with renal insufficiency.
Main Results:
- No significant differences in hospital stay, major morbidity, or perioperative mortality between primary and secondary repair groups.
- High rates of hypertension improvement/cure (94% vs. 90%) and stable/decreased creatinine (74% vs. 82%) in both groups.
- Overall survival was 89% at a mean follow-up of 22 months.
Conclusions:
- Surgical revascularization for renal artery stenosis yields favorable outcomes regardless of prior angioplasty attempts.
- Renal artery angioplasty does not appear to compromise subsequent surgical results in carefully monitored patients.