Are simultaneous aortic reconstruction and renal revascularization safe and effective?

Area of Science:

• Vascular Surgery
• Nephrology
• Cardiovascular Medicine

Background:

• Uncontrollable hypertension often stems from severe aorto-renal atherosclerosis.
• Simultaneous aortic reconstruction and renal revascularization present a complex surgical challenge.
• Previous reports suggested high operative risks for combined procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of simultaneous aortic reconstruction and renal revascularization in patients with severe aorto-renal atherosclerosis.
• To assess the impact of the procedure on hypertension control and renal function.
• To determine the long-term outcomes and operative risks associated with this combined surgical approach.

Main Methods:

• Retrospective analysis of 40 patients with uncontrollable hypertension undergoing renal revascularization between 1983 and 1989.
• Focus on 21 patients who underwent simultaneous aortic and renal revascularization.
• Surgical techniques included aortic reconstruction with Dacron grafts and renal revascularization via bypass or transaortic endarterectomy.

Main Results:

• Operative mortality rate was 4.7% (1 death).
• In patients with renal insufficiency (n=11), mean creatinine clearance improved significantly from 0.61 to 0.94 ml/sec (p<0.01).
• No instances of worsening hypertension or renal function deterioration observed during a mean follow-up of 39.1 months.

Conclusions:

• Simultaneous aortic reconstruction and renal revascularization is a viable treatment for severe aorto-renal atherosclerosis.
• The procedure can be performed with acceptably low operative risk.
• Significant and persistent improvements in hypertension control and renal function can be expected post-surgery.