Alternatives to aortorenal revascularization

Renal revascularization is a proven means of treating patients with renal artery disease and resultant hypertension. Currently aortorenal bypass is the mainstay of surgical treatment in most institutions. Alternate methods for renal revascularization are now available when use of abdominal aorta would be hazardous for aortorenal revascularization. Relative contraindications for use of the aorta in reconstructive renovascular surgery are previous aortic surgery, severe atherosclerosis, and asymptomatic small abdominal aortic aneurysms. Absolute contraindications include atheromatous obliterative disease, postirradiation aortitis, and retroperitoneal suppurative process involving the infrarenal aorta. The indications and surgical techniques of various forms of extra-aortic renal bypass procedures are presented. These extra-aortic procedures have effectively restored renal blood flow and are less hazardous than aortic replacement and concomitant renal revascularization.