Hepatorenal and splenorenal artery bypass for salvage of renal function

Hepatic and splenic arteries have been used increasingly as inflow sources to avoid aortorenal bypass in patients whose cardiac dysfunction may be exacerbated by aortic clamping and in patients with previous aortic grafting in whom periaortic dissection is more hazardous than incising undisturbed tissue planes. During an 18-month period, eight patients with atherosclerotic renal artery stenosis and azotemia were treated with six hepatorenal and five splenorenal artery bypasses. Serum creatinine improved initially in all patients. Severe hypertension, present in five patients, improved significantly in four (80%). In one-half the gastroduodenal branch of the hepatic artery was suitable for end-to-end anastomosis to the renal artery, obviating the need for an interposition graft. Hepatorenal bypass is a safe, simple procedure that has been associated with few complications, although occasional transient subclinical evidence of hepatic dysfunction has been reported. Splenorenal bypass requires a relatively more hazardous exposure and is associated with a low risk of splenic and pancreatic injury, especially when the spleen and splenic flexure of the colon are mobilized to expose the splenic artery. The risk of splenic injury is substantially reduced when the splenic artery is approached through the retroperitoneum at the base of the transverse mesocolon as described.