Use of the splenic and hepatic arteries for renal revascularization

During a 16-year period at the Massachusetts General Hospital 77 patients underwent 79 procedures (29 hepatorenal bypasses, 50 splenorenal arterial anastomoses) for treatment of renovascular hypertension, renal preservation, or both. The procedure was chosen primarily to avoid a diseased or scarred aorta in 41, to allow a staged approach to bilateral renal artery stenoses or multiple vascular lesions in 17, as a "lesser operation" for five poor-risk patients, for complex problems including trauma, mycotic aneurysm, aortic dissection, thoracoabdominal aneurysm, and renal artery aneurysm in five, and as the procedure of choice in 11 patients. The perioperative mortality rate was 6% for the 77 patients studied. No hepatic dysfunction was seen. Deterioration of renal function occurred on three occasions but only in patients with bilateral simultaneous repair. Cure or improvement of hypertension was achieved in 52 of 63 patients and renal function preserved or improved in 67 of 77 patients. Long-term functional results remain good during follow-up periods up to 14 years. Our experience indicates that use of the hepatic or splenic artery may provide a safe and largely successful alternative for renal revascularization in selected circumstances.