Ex situ repair of complex renal artery lesions

A total of 59 patients (from a personal series of 354) underwent ex situ repair of complex renal artery lesions. This series comprised 27 males and 32 females, of whom 15 were children and 44 adults, with ages ranging from 17 months to 70 years. The operated lesions were aneurysms with or without associated stenosis, spontaneous dissection, extensive fibrodysplasia and reoperations on the renal artery. In all patients, the kidney was exteriorized and cooled by perfusion of cold Collins' solution. The kidney was reimplanted after repair in either the loin or the iliac fossa. An arterial substitute was used in 42 patients. No mortality was observed. There were three cases of postoperative thrombosis of the repaired artery. Segmental thrombosis leading to partial atrophy of the kidney occurred in three patients. During long-term follow-up, one repeat stenosis and two fusiform dilatations of the venous autografts were observed. All other repairs (85%) were successful. Arterial hypertension in 46 patients was cured in 33 cases (72%) and improved in eight (17%). Renal function was improved after repair of severe stenotic lesions impairing renal blood flow restored normal circulation to the organ. Ex situ repair must be reserved for: (1) multiple lesions involving terminal branches of the renal artery for which prolonged circulatory arrest is required; and (2) lesions profoundly situated in the renal sinus that are difficult to treat by conventional surgery.