Surgical Revascularization of Atherosclerotic Renovascular Disease: State of the Art
AbstractNo single method provides optimal open operative repair for every type of renovascular disease. Aortorenal bypass is the most versatile technique; however transaortic thromboendarterectomy is especially useful for orificial atherosclerosis that involves multiple renal arteries. Regardless of the method of repair, intraoperative assessment with duplex sonography ensures flawless reconstruction, contributing to 96% primary patency at 5-years followup. When applied to our 500 consecutive, hypertensive adults, 85% demonstrated either cured (12%) or improved (75%) hypertension after operation. Among patients with ischemic nephropathy (serum creatinine 2 1.8 mg/dL), 58% demonstrated a greater than 20% increase in estimated glomerular filtration rate, including 28 of 35 patients permanently removed from dialysis-dependence. Compared with the cumulative data regarding renal artery balloon angioplasty and stenting of ostial atherosclerosis, open operative repair yields superior blood pressure, renal function, and follow-up anatomic results.