[Combined surgery of subrenal aorta and renal arteries]

Frequency and place of renal artery surgery during reconstructive aorto-iliac operation are discussed in relation to 25 patients operated upon between 1980 and 1986, these representing 4.1% of cases undergoing aorto-iliac surgery during the same period. Aortic lesions included 6 aneurysms of infrarenal aorta and 18 stenotic and/or occlusive lesions: 16 stage II, 1 stage III and 1 stage IV. Renal artery repair was for renovascular hypertension (13 cases), for renal prophylaxis (6 cases) and for technical reasons (5 cases), and consisted of direct reimplantation (3 cases), thrombo-endarterectomy (5 cases, including 2 trans-aortic by thoracolumbar approach) or bypass (18 cases, including 11 venous grafts-3 in a same patient - and 7 prostheses). In contrast to literature data reporting an intraoperative mortality of between 6.8 and 12% no postoperative death occurred in this series. Morbidity observed was 2 asymptomatic postoperative renal thromboses, 1 stenosis of marked degree of a renal artery after trans-aortic disobstruction treated successfully by endoluminal dilatation and finally, one case of acute renal insufficiency becoming chronic. No early or late complications were related to repair surgery to aorta and to lower limbs. Long-term results were comparable with those of other series, with recovery from hypertension in 15.3% of cases, improvement in 46.1% and persistence in 38.4%. The lack of mortality in this short series has led to wide indications for combined aortic and renal surgery, but definitive conclusions cannot be drawn because of the small number of patients treated.