Renal artery reconstruction: extended indications

Renal artery reconstruction has traditionally been limited to cases of documented renal artery hypertension. We report our experience with renal artery reconstruction on 32 arteries in 23 patients over a three-year period. These procedures were done for renovascular hypertension in nine patients, for renal preservation in seven patients, and concomitantly with aortic reconstruction in seven patients. Aortorenal bypass was the primary method of reconstruction, with thromboendarterectomy, primary reanastomosis, and splenorenal bypass being used less frequently. Significant improvement in hypertension was seen in virtually all patients, with improvement in renal function seen in all patients operated on for threatened renal function. In no case did renal function deteriorate postoperatively, and there have been no operative deaths. Major complications included postoperative hemorrhage (four patients), myocardial infarction (one patient), and restenosis of an artery after previous thromboendarterectomy (one patient). Renal artery revascularization procedures are safe and useful in selected patients with hypertension and ischemic nephropathy.