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Ischemic nephropathy and concomitant aortic disease: a ten-year experience
E L Chaikof1, R B Smith, A A Salam
1Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Journal of Vascular Surgery
|January 1, 1994
Summary
Surgical repair of aortic disease with renal revascularization can improve kidney function in some patients. However, those with severely impaired kidney function pre-operation are unlikely to recover and may require dialysis.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Vascular Surgery
Background:
- Renal preservation after surgical intervention for aortic disease is not well-defined.
- Patients with renal insufficiency and concomitant atherosclerotic aortic and renovascular disease present unique challenges.
Purpose of the Study:
- To evaluate the durability of renal preservation after surgical intervention in patients with renal insufficiency and associated aortic disease.
- To assess the outcomes of combined aortic repair and renal revascularization.
Main Methods:
- A review of 50 patients with renal insufficiency (creatinine > or = 1.8 mg/dl) undergoing aortic repair and renal revascularization between 1982 and 1992.
- Analysis of preoperative and postoperative estimated glomerular filtration rate (EGFR), operative management, and long-term follow-up outcomes including mortality and dialysis requirements.
Main Results:
- The 30-day operative mortality was 2.0%.
- At a median follow-up of 49 months, 18.4% of patients required dialysis, and 61% survived at 5 years.
- A preoperative EGFR < 20 ml/min or creatinine level >= 3 mg/dl significantly predicted the need for long-term dialysis.
Conclusions:
- Combined aortic and renal revascularization can lead to early renal function improvement in nearly half of patients.
- Renal preservation is unsustainable in patients with severely compromised preoperative renal function.
- Intervention before significant functional decline is crucial to minimize the risk of eventual dialysis.