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Chronic renal artery occlusion: nephrectomy versus revascularization
T C Oskin1, K J Hansen, J S Deitch
1Departments of General Surgery and Public Health Sciences, Division of Surgical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Journal of Vascular Surgery
|January 12, 1999
Summary
Surgical management of chronic atherosclerotic renal artery occlusion (RA-OCC) showed that revascularization improved renal function and survival, especially in unilateral cases. Both revascularization and nephrectomy offered similar blood pressure benefits for RA-OCC patients.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Vascular Surgery
Background:
- Atherosclerotic renal artery occlusion (RA-OCC) is a significant cause of renovascular hypertension and renal dysfunction.
- Surgical intervention aims to restore renal perfusion and preserve kidney function in affected patients.
- Comparing revascularization versus nephrectomy for RA-OCC is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the surgical management strategies for chronic atherosclerotic renal artery occlusion (RA-OCC).
- To compare the outcomes of revascularization versus nephrectomy in hypertensive patients with RA-OCC.
- To assess the impact of surgical intervention on blood pressure, renal function, and patient survival.
Main Methods:
- Retrospective analysis of 397 patients with atherosclerotic renal artery disease from 1987-1996.
- Focus on 95 hypertensive patients with 100 RA-OCCs, comparing revascularization (n=?) and nephrectomy (n=?).
- Evaluation of perioperative morbidity/mortality, blood pressure response, renal function changes, and survival rates, compared to 302 patients with renal artery stenosis (RAS).
Main Results:
- Perioperative mortality was similar between RA-OCC (5.2%) and RAS (4.0%) groups.
- Both revascularization and nephrectomy provided comparable blood pressure benefits in RA-OCC patients.
- Revascularization for unilateral RA-OCC significantly improved renal function (P <.01), unlike nephrectomy alone. Improved renal function correlated with increased survival (P <.01).
Conclusions:
- Revascularization is preferred over nephrectomy for RA-OCC in select hypertensive patients with a normal distal artery, due to improved renal function and survival benefits.
- While both procedures offer blood pressure benefits, only revascularization demonstrated significant improvement in excretory renal function for unilateral disease.
- Enhanced renal function post-revascularization is independently associated with improved survival and dialysis-free survival in RA-OCC patients.