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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
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.
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.
- 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.