Document Detail

Renal artery repair: consequence of operative failures.
MedLine Citation:
PMID:  9605659     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This report examines the blood pressure and renal function response in 20 consecutive patients after secondary renal revascularization following failed operative repair. SUMMARY BACKGROUND DATA: Most reports describing operative failure of renal artery (RA) repair emphasize the technical aspects of redo RA reconstruction and the immediate blood-pressure response to secondary operation. This report examines the eventual renal function and estimated survival after secondary intervention. METHODS: Primary methods of RA reconstruction, primary blood pressure and renal function responses, and causes of failed RA repair were defined for 20 patients requiring reoperation for recurrent hypertension or renal insufficiency. These parameters were compared with secondary procedures and eventual blood pressure and renal function response. The eventual outcome for these 20 patients was compared with 514 patients managed by primary renal revascularization during the same period. RESULTS: Failure of primary RA repair correlated with complex fibromuscular dysplasia requiring branch ex vivo reconstruction (p = 0.020). RA thrombosis frequently required nephrectomy (83%), whereas RA stenosis was successfully reconstructed (91 %; p = 0.001). Primary and secondary blood-pressure responses were equivalent (94% vs. 95% cured or improved); however, primary and eventual renal function responses differed significantly (p = 0.015), with seven patients dialysis-dependent on follow-up. Eventual dialysis dependence was associated with preoperative azotemia (p = 0.022), bilateral failure of primary RA repair (p = 0.007), and an increased risk of follow-up death (p = 0.002). Considering all 534 patients, failed RA repair demonstrated a significant and independent association with eventual dialysis dependence and decreased dialysis-free survival. CONCLUSIONS: Contemporary rates of reoperation after surgical RA repair are low. In properly selected patients, beneficial blood-pressure response is reliably observed after both primary and secondary operative procedures. However, secondary procedures are associated with a significant and independent risk of eventual dialysis dependence.
K J Hansen; J S Deitch; T C Oskin; J Ligush; T E Craven; R H Dean
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Annals of surgery     Volume:  227     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-06-11     Completed Date:  1998-06-11     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  678-89; discussion 689-90     Citation Subset:  AIM; IM    
Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-10958, USA.
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MeSH Terms
Arteriosclerosis / surgery*
Blood Pressure
Fibromuscular Dysplasia / surgery*
Kidney Function Tests
Middle Aged
Renal Artery / surgery*
Renal Artery Obstruction / surgery*
Renal Dialysis
Treatment Failure
Grant Support
1R01JD47414//PHS HHS

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

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