Antegrade aortorenal bypass graft: a new alternative

The search for a site of origin for renal artery bypass grafting other than the inclusion aorta has resulted in a variety of recommendations, including use of the splenic, hepatic, gastroduodenal, and superior mesenteric arteries and even retrograde bypass grafts originating from the iliac artery. The present study has described our early experience with a new procedure utilizing an antegrade aortorenal bypass graft originating in the mediastinal supraceliac aorta. Eight patients underwent operation; four for renovascular hypertension and four for renal salvage plus hypertension. There were no operative deaths. All grafts (three saphenous and five polytetrafluoroethylene) functioned well, as judged by clinical response and renal scan. One graft failed at 6 weeks. Hypertension was cured in three patients and improved in four at a mean follow-up of 27 months (range 3 to 58 months). Improved hemodynamic performance of antegrade flow, avoidance of liver and biliary complications, and applicability to the right or left kidney are the advantages of this technique. When renal artery reconstruction is required and the infrarenal aorta is to be avoided, we believe this operation is a useful alternative.