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Related Experiment Videos

Is renal revascularization in diabetic patients worthwhile?

K J Hansen1, A H Lundberg, M E Benjamin

  • 1Department of General Surgery, Wake Forest University Medical Center, NC, USA.

Journal of Vascular Surgery
|September 1, 1996
PubMed
Summary

Surgical repair of atherosclerotic renovascular disease (RVD) in diabetic adults improved blood pressure in most patients, but less effectively than in non-diabetics. Poor renal function predicted worse outcomes, highlighting the importance of kidney health in RVD management.

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Area of Science:

  • Cardiovascular Surgery
  • Nephrology
  • Diabetology

Background:

  • Atherosclerotic renovascular disease (RVD) significantly impacts hypertensive patients with diabetes mellitus.
  • Management of RVD in this population presents unique challenges due to comorbidities and potential renal dysfunction.

Purpose of the Study:

  • To describe the surgical management outcomes of atherosclerotic RVD in hypertensive adults with diabetes mellitus.
  • To compare outcomes in diabetic patients with those of non-diabetic patients undergoing similar procedures.

Main Methods:

  • Retrospective review of 54 consecutive hypertensive diabetic patients undergoing operative repair of atherosclerotic RVD between 1987 and 1995.
  • Assessment of blood pressure and renal function response, operative mortality, and dialysis-free survival.

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  • Comparison of outcomes with 291 non-diabetic patients.

    • Main Results:

    • Operative mortality was 7.4%. Among survivors, 72% had improved blood pressure, and 40% with renal dysfunction showed improved kidney function.
    • Diabetic patients had a lower rate of beneficial blood pressure response (72% vs. 89%) and increased risk of dialysis or death compared to non-diabetics.
    • Preoperative and postoperative renal function, diabetes mellitus, patient age, and congestive heart failure were independent predictors of mortality or need for dialysis.

    Conclusions:

    • Operative repair of atherosclerotic RVD offers beneficial blood pressure control in most selected diabetic patients, though less frequently than in non-diabetics.
    • Pre- and post-operative renal function in diabetics is critical for predicting progression to dialysis and survival.
    • While improved renal function post-operation correlates with better survival, predicting the response to renal revascularization remains challenging.