Vol 8, No 6 (2004)
Original paper
Published online: 2004-12-14

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Results of surgical treatment of renal artery stenosis

Lech Cierpka, Marian Duraj, Jerzy Chudek, Grzegorz Oczkowicz, Beata Czerwieńska, Danuta Kokocińska, Andrzej Więcek
Nadciśnienie tętnicze 2004;8(6):385-392.

Abstract

Background A great progress in percutaneous non-surgical angioplasty - PTRA (with or without stenting) has taken place in the last few years. However, there is still a group of patients who cannot be treated with these methods. The aim of the present study was to summarize the effects of surgical treatment of renal artery stenosis performed in our center from 1995 to 2002.
Material and methods Forty-three patients, including 33 with renovascular hypertension who were not suitable for the PTRA, 4 patients with renal failure due to critical stenosis or the occlusion of renal arteries and 6 patients with artery stenosis of the transplanted kidney were referred to surgical angioplasty. 48 surgical reconstructions were performed. In 5 patients both renal arteries were reconstructed. Simultaneously, in 14 patients surgical reconstructions of aorta and iliac arteries were done. The effect of surgery on blood pressure and serum creatinine concentration during the perioperative period, after a year, and in June 2003 (mean observation period was 67, range: 9-96 months) were analysed. In all survivals Doppler ultrasound examination for discrimination of re-stenosis was performed in long term observation. The therapeutic success was considered in the following clinical conditions: normalization of blood pressure or the reduction of diastolic blood pressure at least 15 mm Hg or reduced number of antihypertensive agents in hypertensive patients, or decrease of serum creatinine concentration ≥ 20% in patients with renal failure.
Results Three patients (7.0%) died in the perioperative period and another 3 during the follow up period (not related to renal failure). In 3 patients unilateral nephrectomy was performed and in the 2 others - the kidneys were nephrectomized during the second surgery (altogether 5 kidneys were removed - 11.6%). During the long term observation, renal cirrhosis occurred in 7 patients (17.3%). Permanent blood pressure normalization was achieved in 6 out of 31 hypertensive patients (19.4%) and in the additional 15 individuals improvement of blood pressure control was noticed (48.4%). Renal revascularization performed in patients with affected kidneys of the length lower than 9 cm, prevented the development of renal cirrhosis in 40% of cases. The improvement of renal excretory function was observed in 2 out of 3 survivals with renal failure. Longer than 3 years graft survival was achieved in 5 out of 6 patients with artery stenosis of the transplanted kidney.
Conclusions Surgical treatment of renal artery stenosis is still recommended in patients with renovascular hypertension and severe atherosclerotic lesions in aorta or in patients with renal artery aneurysms. Such therapy is also effective in patients with renal artery stenosis of the transplanted kidney.

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