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Published on: July 19, 2011
Multi-branch renal artery lesions: surgical options and results
1Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee 37212.
Abstract:
Renovascular lesions affecting more than one primary or secondary renal artery branch represent a challenging therapeutic problem. Over the last 5 years, the authors have treated 20 patients with complex multi-branch renal lesions. The number of renal artery branches per kidney ranged from two to seven. The pathological etiology of the multi-branch lesion was atherosclerotic occlusive disease in ten patients, fibromuscular occlusive disease in four (two with spontaneous dissection), renal artery aneurysm in three and abdominal aortic coarctation in three. Ex vivo techniques were used in nine patients, whereas in situ reconstruction was used in 11. Ten patients had a complex procedure involving aortic or other visceral reconstruction; two patients had solitary kidneys. There was one death in the series from an intraoperative anesthetic complication. One primary nephrectomy was performed after ex vivo exploration revealed unreconstructable disease in a significant number of branches. Severe hypertension present in all the patients before surgery was cured in five patients and improved in 14 after the operation. Renal insufficiency, present in nine patients before surgery, was improved in all cases.
Insights
Treating complex renal artery lesions involving multiple branches is challenging. Surgical reconstruction, using ex vivo or in situ techniques, effectively improved hypertension and renal insufficiency in most patients.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Cardiology
Background:
- Complex renovascular lesions involving multiple renal artery branches pose significant therapeutic challenges.
- These lesions can lead to severe hypertension and renal insufficiency.
Purpose of the Study:
- To evaluate the outcomes of surgical reconstruction for complex multi-branch renal artery lesions.
- To assess the impact of these procedures on hypertension and renal function.
Main Methods:
- Retrospective analysis of 20 patients with complex multi-branch renal lesions treated over 5 years.
- Surgical techniques included ex vivo and in situ reconstruction.
- Procedures were performed for atherosclerotic occlusive disease, fibromuscular occlusive disease, renal artery aneurysm, and abdominal aortic coarctation.
Main Results:
- Surgical reconstruction was successful in most patients, with one death due to anesthetic complications.
- Hypertension was cured in 5 patients and improved in 14.
- Renal insufficiency improved in all 9 patients who had it preoperatively.
Conclusions:
- Surgical reconstruction of complex multi-branch renal artery lesions is a viable and effective treatment option.
- These interventions can significantly improve or cure associated hypertension and renal insufficiency.
- Careful patient selection and surgical technique are crucial for successful outcomes.
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