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Antegrade aortorenal bypass graft: a new alternative
1Department of Surgery, Virginia Mason Medical Center, Seattle, Washington.
Insights
This study introduces a new antegrade aortorenal bypass graft from the supraceliac aorta for renal artery reconstruction. The procedure showed promising results, offering a viable alternative when the infrarenal aorta is unsuitable.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
Background:
- Traditional renal artery bypass grafting often uses the infrarenal aorta.
- Alternative graft origins have been explored to avoid complications or when the aorta is unsuitable.
Purpose of the Study:
- To describe the early experience with a novel antegrade aortorenal bypass graft originating from the mediastinal supraceliac aorta.
- To evaluate the safety and efficacy of this technique for renal artery reconstruction.
Main Methods:
- Eight patients underwent antegrade aortorenal bypass grafting from the supraceliac aorta.
- Grafts utilized saphenous vein or polytetrafluoroethylene (PTFE).
- Indications included renovascular hypertension and renal salvage.
Main Results:
- No operative deaths occurred.
- All grafts demonstrated initial function, with one failure at 6 weeks.
- Hypertension was cured in 3 patients and improved in 4, with a mean follow-up of 27 months.
Conclusions:
- Antegrade bypass from the supraceliac aorta is a safe and effective alternative for renal artery reconstruction.
- Advantages include improved hemodynamics, avoidance of hepatic/biliary complications, and applicability to either kidney.
- This technique is a useful option when infrarenal aortic access is not feasible.
Abstract:
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.