Simultaneous aortic reconstruction and bilateral renal revascularization. Is this a safe and effective procedure?

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Nephrology

Background:

• Severe aortorenal atherosclerosis presents significant challenges in managing hypertension and renal insufficiency.
• Simultaneous aortic and renal revascularization is a complex procedure for patients with widespread atherosclerotic disease.

Purpose of the Study:

• To evaluate the safety and efficacy of simultaneous aortic and bilateral renal revascularization in patients with severe aortorenal atherosclerosis.
• To assess the impact of this combined surgical approach on blood pressure control and renal function.

Main Methods:

• A cohort of 32 patients with severe aortorenal atherosclerosis underwent simultaneous aortic reconstruction and bilateral renal revascularization between 1982 and 1987.
• Aortic reconstruction utilized Dacron grafts, while renal revascularization involved bypass or transaortic endarterectomy.
• Patient outcomes, including mortality, blood pressure response, and serum creatinine levels, were meticulously tracked.

Main Results:

• The operative mortality rate was low at 3% (one death from pulmonary embolism).
• Significant blood pressure improvement was observed in 90% of survivors.
• Renal function improved markedly, with mean serum creatinine decreasing from 2.8 mg/dl preoperatively to 1.65 mg/dl postoperatively (p < 0.001), especially in those with severe dysfunction.

Conclusions:

• Simultaneous aortic reconstruction and bilateral renal revascularization is a safe and effective treatment for severe aortorenal atherosclerosis.
• The procedure offers a high likelihood of significant and sustained improvement in both hypertension and renal dysfunction.
• This surgical strategy provides a valuable option for managing complex vascular disease affecting the aorta and renal arteries.