Document Detail


Combined aortic and visceral arterial reconstruction: risks and results.
MedLine Citation:
PMID:  2243407     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The indications, morbidity, and efficacy of combined reconstruction of the abdominal aorta and visceral arteries (renal and superior mesenteric; excluding suprarenal aortic aneurysms) were analyzed retrospectively in 29 consecutive patients who underwent surgery from June 1984 through February 1990. Seventeen men and 12 women ages 32 to 76 years (mean, 66 years) were studied. Follow-up was complete in all patients to either death or calendar year 1989 to 1990 (mean, 31.9 months; range, 2 to 66 months). All patients underwent bypass of angiographically proven severe lesions of one renal artery (19 patients), both renal arteries (8 patients), or the superior mesenteric artery and renal arteries (2 patients), in concert with synthetic distal aortic replacement for occlusive disease (10 patients) or aneurysm (19 patients). Indications for renal artery repair included severe hypertension in 13 patients, ischemic renal insufficiency in 8 patients, and lesion morphology alone in 8 patients. Operative mortality rate was 3 of 29 (10.3%), and each death was the result of multisystem organ failure. Nonfatal complications occurred in 11 of the 26 survivors (42%), and this group differed significantly from the uncomplicated 15 patients only in having a higher mean preoperative serum creatinine (2.5 +/- 1.1 mg/dl vs 1.6 +/- 0.9 mg/dl, p = 0.04, t test). The mortality rate of patients with preoperative serum creatinine greater than or equal to 2.0 mg/dl, was 15.4% (2/13 patients), compared to 6.2% (1/16) in patients with creatinine less than 2.0 mg/dl. Three late deaths occurred (2 stroke, 1 cancer). Hypertension control improved in 64% of patients overall, and in 7 of 9 patients whose major operative indication was renovascular hypertension. Renal function remained stable or improved in 12 of 15 patients (80%) with renal insufficiency, but 3 patients progressed to require dialysis. Long-term graft patency was demonstrated by angiography or on duplex scan in all studied survivors (21 patients). Although operative risks are clearly increased compared to less complex vascular procedures, careful patient selection and management will yield a favorable outcome in most patients with such combined lesions.
Authors:
R G Atnip; M M Neumyer; D A Healy; B L Thiele
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  12     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  1990 Dec 
Date Detail:
Created Date:  1991-01-03     Completed Date:  1991-01-03     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  705-14; discussion 714-5     Citation Subset:  IM    
Affiliation:
Department of Surgery, College of Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aorta, Abdominal / surgery*
Aortic Aneurysm / mortality,  surgery
Arterial Occlusive Diseases / mortality,  surgery
Blood Vessel Prosthesis
Female
Follow-Up Studies
Humans
Hypertension, Renovascular / mortality,  surgery
Ischemia / mortality,  surgery
Kidney / blood supply
Male
Mesenteric Arteries / surgery*
Middle Aged
Renal Artery / surgery*
Renal Artery Obstruction / mortality,  surgery
Retrospective Studies
Risk Factors
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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