The occluded renal artery: an ongoing surgical challenge

Area of Science:

• Vascular Surgery
• Nephrology
• Hypertension Management

Background:

• Chronic renal artery occlusion presents management challenges in patients with renovascular hypertension or renal insufficiency.
• Nephrectomy and revascularization are established treatment options.

Purpose of the Study:

• To review the early and late functional outcomes of nephrectomy with contralateral revascularization versus revascularization of the occluded renal artery.
• To evaluate the efficacy of these interventions in patients with chronic renal artery occlusion.

Main Methods:

• Retrospective review of 30 patients with chronic main renal artery occlusion (December 1982 - August 1993).
• Patients were divided into two groups: Group I (nephrectomy plus contralateral revascularization) and Group II (revascularization of the occluded renal artery).
• Outcomes assessed included estimated glomerular filtration rate (eGFR) and progression to end-stage renal disease (ESRD).

Main Results:

• No perioperative deaths occurred in either group (16 patients in Group I, 14 in Group II).
• eGFR remained stable or improved in 15/16 (Group I) and 13/14 (Group II) patients post-operatively.
• At a mean follow-up of 45 months, 10/13 (Group I) and 7/11 (Group II) patients avoided ESRD. Hypertension improved or was cured in 16/21 patients.

Conclusions:

• Both nephrectomy with contralateral revascularization and isolated revascularization of the occluded renal artery offer favorable early and late functional outcomes for chronic renal artery occlusion.
• These surgical interventions can preserve renal function and improve hypertension control in select patient populations.