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Use of a Hanging-weight System for Isolated Renal Artery Occlusion
Published on: July 19, 2011
The occluded renal artery: durability of revascularization
Insights
Revascularization of occluded renal arteries effectively controlled hypertension in most patients, with durable results observed over long-term follow-up. This procedure offers a significant benefit for managing renovascular hypertension.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Vascular Surgery
Background:
- Renal artery occlusion is a significant cause of secondary hypertension.
- Atherosclerosis is the predominant etiology, followed by fibromuscular dysplasia and other rare conditions.
- Contralateral renal artery disease and extrarenal atherosclerosis are common comorbidities.
Purpose of the Study:
- To evaluate the efficacy and durability of renal artery revascularization in patients with occluded renal arteries.
- To assess the impact of revascularization on hypertension control and renal function preservation.
- To analyze outcomes based on surgical techniques and patient characteristics.
Main Methods:
- A retrospective review of 50 patients (38 male, 12 female) who underwent revascularization for 51 occluded renal arteries between 1970 and 1982.
- Surgical procedures included renal artery bypass, endarterectomy, and reimplantation.
- Follow-up included assessment of blood pressure control and renal function.
Main Results:
- Hypertension improved in 45 of 46 patients at hospital dismissal.
- Long-term follow-up (mean 50.2 months) showed 34 patients remained normotensive, and five had less hypertension.
- Atherosclerosis accounted for the majority of occlusions (43 patients).
- Operative mortality was low (three deaths).
Conclusions:
- Revascularization of occluded renal arteries is an effective treatment for controlling hypertension.
- The beneficial effects on blood pressure are durable in the majority of patients.
- Renal revascularization should be considered for selected patients with renovascular hypertension.
Abstract:
Between 1970 and 1982, 50 patients (38 male and 12 female) underwent revascularization of 51 occluded renal arteries. Ages ranged from 8 to 71 years (mean 54.6 years). Occlusion was caused by atherosclerosis in 43 patients, fibromuscular dysplasia in three, chronic dissection in two, abdominal aortic coarctation in one, and neurofibromatosis in one. Contralateral renal artery occlusive disease occurred in 22 patients. Extrarenal atherosclerosis occurred in 44 patients. Mean preoperative serum creatinine level ranged from 0.5 to 8.4 mg/dl (mean 1.9 mg/dl). No patient required preoperative dialysis. Length of the involved kidney ranged from 8.4 to 14.5 cm (mean 11.5 cm). Indication for renal revascularization was hypertension in 49 patients and preservation of renal function in one. Renal artery bypass was performed in 36 patients, renal artery endarterectomy in six, transaortic endarterectomy in five, and reimplantation of the renal artery in three. Simultaneous revascularization of the contralateral renal artery was performed in 20 patients. There were three operative deaths. At hospital dismissal, hypertension had improved in 45 of 46 patients. Follow-up periods ranged from 4 months to 12 years (mean 50.2 months). Thirty-four patients remained normotensive, five still had less hypertension, and seven became worse. These data demonstrate that revascularization of an occluded renal artery can be effective in controlling hypertension and that this effect is durable in the majority of patients.
