Surgical Renovascular Reconstruction for Renal Artery Stenosis and Aneurysm: Long-Term Durability and Survival.

OBJECTIVE: To study functional outcome, mortality, and dialysis free survival in patients undergoing open primary surgical repair of renal artery stenosis (RAS) or aneurysm (RAA).

METHODS: This was a retrospective single centre study of patients undergoing open surgical renal artery reconstruction from 1993 to 2007. Blood pressure, renal function, dialysis dependence, vessel patency, and mortality were registered. Survival was investigated by cross matching with the population registry, yielding up to 20 years of follow up.

RESULTS: Of the 40 patients operated on, 25 (63%) were women. RAS was the indication for reconstruction in 31 patients; 23 had atherosclerotic aetiology (ARAS), and eight had fibromuscular dysplasia (FMD). Nine patients had RAA. Patients with ARAS were older (p = .008), had more extensive peripheral arterial disease (p = .004), and inferior renal function (p = .003) compared with patients with FMD or RAA. In FMD and RAA, the right renal artery was affected in 13/17 (76%) cases, whereas in ARAS the disease was evenly distributed. In patients with ARAS, 15/25 (60%) stenotic renal arteries (two bilateral procedures) were managed by aorto-renal bypass, and 2/25 (8%) through ilio-renal bypass. In 8/25 (32%) endarterectomy was performed. In FMD, all but one patient underwent aorto-renal bypass. Early mortality was 2.5% (one patient with ARAS). One patient with ARAS required dialysis post-operatively. Systolic blood pressure was significantly reduced in patients with ARAS, from 180 mmHg (median) pre-operatively to 155 mmHg at one month (p = .003) and 160 mmHg at one year (p = .03). Need for medication decreased from three or more drugs to two drugs at one month (p = .01). In FMD, there was a similar tendency. Three patients underwent re-intervention for restenosis: two endovascularly and one by open surgery. The overall 5 year survival was 88%. Median follow up was 10.6 years.

CONCLUSION: Open surgical renal arterial reconstruction was performed with low mortality, fairly low morbidity, and excellent durability. Open surgery should still be considered a therapeutic option in complex renal artery disease.