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Acute non-traumatic obstructions of the renal artery
1Consultation de Chirurgie, Hôpital Beaujon, Clichy, France.
Abstract:
Twenty patients were operated upon for acute obstruction of their main renal arteries (25 kidneys at risk), 18 hours to 68 days after the onset of obstruction. Three nephrectomies were necessary because of total renal infarction but revascularization was possible in all the other cases. The postoperative mortality rate was 15%; definitive kidney salvage rate was 64%. The function of the preserved kidneys was usually satisfactory. This surgical experience has led us to the following conclusions: acute obstruction of a main renal artery does not necessarily cause renal infarction as viability of the kidney can be maintained over long periods of time by the collateral circulation; neither non-function of the kidney, nor the duration of renal artery obstruction must be regarded as signs of renal infarction; no investigation can provide information as to the exact condition of the kidney before surgery. Apart from critically ill patients or segmental renal obstructions, the treatment should be surgical, irrespective of the time that has elapsed from the onset of the obstruction.
Insights
Acute renal artery obstruction can be successfully treated surgically, even after delayed presentation. Viable kidney salvage is possible due to collateral circulation, challenging assumptions about infarction timelines.
Area of Science:
- Vascular Surgery
- Nephrology
- Emergency Medicine
Background:
- Acute main renal artery obstruction poses a risk to kidney viability.
- Timeliness of intervention is often considered critical for renal salvage.
Purpose of the Study:
- To evaluate surgical outcomes for acute main renal artery obstruction.
- To determine the impact of delayed intervention on kidney salvage rates.
Main Methods:
- Surgical revascularization was performed on 20 patients (25 kidneys) with acute main renal artery obstruction.
- Intervention timing ranged from 18 hours to 68 days post-obstruction.
Main Results:
- Revascularization was successful in most cases, with only 3 nephrectomies required due to total infarction.
- The definitive kidney salvage rate was 64%, with satisfactory function in preserved kidneys.
- Postoperative mortality was 15%.
Conclusions:
- Kidney viability can be maintained via collateral circulation despite prolonged obstruction.
- Renal non-function or obstruction duration are unreliable indicators of infarction.
- Surgical intervention is recommended regardless of time elapsed, except in critically ill patients or segmental obstructions.