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[Extracorporeal arterial reconstructive surgery in complex vasculo-renal pathology]
J M Rodríguez Luna1, F J Burgos Revilla, A Fernández Fernández
1Servicio de Urología, Hospital Ramón y Cajal, Madrid, España.
Archivos Espanoles De Urologia
|December 1, 1992
Summary
A complex case of renovascular disease and severe hypertension was treated with ex situ vascular repair and autotransplantation. This surgical approach successfully restored normal blood pressure and renal function.
Area of Science:
- Nephrology
- Vascular Surgery
- Cardiology
Background:
- Severe hypertension refractory to medication in a young male.
- Associated with a hypoplastic left kidney and complex right renovascular disease.
- Renal artery stenosis and saccular aneurysms in three branches of the right renal artery.
Observation:
- Angiotensin-converting enzyme inhibitors were contraindicated due to azotemia risk.
- Percutaneous transluminal angioplasty was not advised due to complex vascular disease.
- Ex situ vascular repair (bench surgery) using the hypogastric artery was performed.
Findings:
- The procedure involved autotransplantation of the repaired right renal artery into the right iliac fossa.
- Excellent surgical outcomes were achieved.
- Arterial pressure and renal function normalized 15 days postoperatively.
Implications:
- Extracorporeal surgery is a viable and effective option for complex renovascular disease involving small renal artery branches.
- This case highlights a successful surgical strategy for managing refractory hypertension secondary to complex renal artery pathology.
- Autotransplantation offers a solution when traditional endovascular or medical treatments are not feasible.