Isolated spontaneous dissection of the renal artery

The aim of this study was to assess the results of surgical treatment in a series of patients who underwent operation for isolated spontaneous dissection of the renal artery. The feasibility of renal artery reconstruction is emphasized.

During a 21-year period (1978-1998), 22 patients (17 men, 5 women) with spontaneous dissection of the renal artery underwent operation. Their mean age was 41 +/- 8.4 years. All patients were admitted with uncontrollable arterial hypertension and underwent the usual investigations performed in subjects with hypertension. Because of bilateral lesions (3 patients), surgical treatment consisted of eight nephrectomies (6 total, 2 partial) and 17 arterial repairs (in 16 patients) carried out by conventional in situ surgery (6 cases) or by extracorporeal repair (11 cases).

There were no postoperative deaths or morbidity in this series. Arterial hypertension was cured in 9 patients (41%), improved in 11 (50%), and unchanged in 2 (9%). Anatomic results of repairs were excellent in 13 patients (81%) and incomplete in three (19%). During long-term follow-up, one late thrombosis of a repaired polar artery and one spontaneous dissection of the contralateral renal artery occurred. In eight patients, late angiographies showed that the results of reconstructions remained stable with time.

Surgical treatment of isolated spontaneous dissection of the renal artery is indicated in patients who have severe uncontrollable hypertension despite extensive medical treatment. Arterial repair is the ideal treatment. It is often possible even when complex lesions are present; in such cases ex vivo surgery affords great safety and ease of repair. Results concerning control of hypertension are satisfactory.