[Vascular surgery in patients with impaired renal function]

Area of Science:

• Nephrology
• Cardiovascular Surgery
• Vascular Surgery

Background:

• Renal artery stenosis (RAS) is a significant cause of secondary hypertension and progressive kidney disease.
• Impaired renal function in RAS patients poses challenges for treatment decisions.
• Surgical intervention aims to restore renal perfusion and function.

Purpose of the Study:

• To assess the impact of surgical correction of renal artery stenosis on renal function in patients with pre-existing renal impairment.
• To evaluate the perioperative outcomes, long-term renal function preservation, and survival rates following surgical RAS treatment.

Main Methods:

• Retrospective analysis of 42 patients with renal artery stenosis and impaired renal function who underwent surgery between 1980 and 1990.
• Preoperative and postoperative evaluation of renal function and blood pressure.
• Follow-up assessment of renal function, survival, and development of end-stage renal disease.

Main Results:

• Perioperative mortality was 5% and morbidity was 21%.
• Renal function was maintained in 90% of patients at hospital discharge.
• At a median follow-up of 66 months, 77% of patients had preserved renal function, with 62% five-year survival, which was lower than a matched population.

Conclusions:

• Surgical reconstruction of renal arteries in patients with RAS and declining renal function can effectively preserve kidney function.
• While most patients avoid dialysis, long-term survival remains a concern, necessitating careful patient selection and management.
• The study highlights the potential benefits of surgical intervention for renal function preservation in select RAS patients.