Ex vivo renal artery reconstruction with autotransplantation

Ex vivo artery reconstruction with autotransplantation was performed on 34 occasions in 33 patients over the past 10 years. The cause of the renal artery disease was fibromuscular disease in 26 patients, arteriosclerosis or reoperation in 5 patients, acute dissection of the thoracic and abdominal aorta in 1 patient, and renal artery aneurysm in a single kidney in 1 patient. All patients were thought to be inoperable by in situ reconstruction. Many patients were treated with a combination of methods including bilateral ex vivo reconstruction, unilateral in situ and contralateral ex vivo reconstruction, and unilateral ex vivo reconstruction with contralateral nephrectomy. Arterial autografts were used in all but one patient to replace the diseased segment of renal artery. Follow-up was from 6 months to 10 years. The following results were obtained. One patient died 7 days after surgery from a ruptured berry aneurysm, and one patient required nephrectomy 6 months after reconstruction because of restenosis. There was no morbidity in the remaining patients. Results in the remaining patients were as follows. Twenty patients were classified as having excellent results, seven patients good results, 2 patients fair results, and two patients poor results. Combining the excellent and good groups showed an 86% cure or considerable improvement rate. These results suggest that ex vivo renal artery reconstruction is an effective and safe method of treating renal vascular hypertension when indicated.