Revascularization of the solitary kidney: A challenging problem in a high risk population

• Published in: Surgery Vol. 120; no. 4; pp. 732 - 737
• Main Authors: Reilly, Jeffrey M., Ruhin, Brain G., Thompson, Robert W., Allen, Brent T., Flye, M Wayne, Anderson, Charles B., Sicard, Gregorio A.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.10.1996
• Subjects: Aged; Aged, 80 and over; Arteriosclerosis - complications; Arteriosclerosis - mortality; Arteriosclerosis - surgery; Blood Vessel Prosthesis; Female; Follow-Up Studies; Humans; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - surgery; Male; Middle Aged; Postoperative Complications; Renal Artery Obstruction - complications; Renal Artery Obstruction - mortality; Renal Artery Obstruction - surgery; Renal Dialysis; Risk Factors; Treatment Outcome
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/S0039-6060(96)80024-9

Background. Patients with significant atherosclerotic stenosis involving the artery to a solitary functioning kidney present a clinical challenge. Methods. From August 1987 through August 1995, 35 of these patients (average age, 68.4±6.9 years) were treated. Comorbid conditions included previous myocardial infarction in 23% of the patients, congestive heart failure (CHF) in 34%, chronic obstructive pulmonary disease in 20%, and diabetes in 20%. The average creatinine level of the patients was 2.5±1.5 mg/dl. Indications for revascularization were hypertension in 86%, hypertensive crisis with CHF in 17%, and renal insufficiency in 69%. Procedures performed included 19 extraanatomic bypasses, 8 concomitant with infrarenal aortic reconstruction and 2 concomitant with thoracoabdominal aortic aneurysm repair; 1 visceral segment endarterectomy; 1 renal artery endarterectomy with reimplantation; 1 superior mesenteric to renal artery bypass; 1 aortorenal bypass; and 2 percutaneous angioplasties with staged nephrectomies. Results. At discharge, 91% of patients had stable or improved renal function with an average creatinine level of 1.7±0.8 mg/dl. Hypertension was cured or improved in 85%. Perioperative mortality was 6%, and major morbidity was 43%, including the need for permanent (9%) and temporary (9%) dialysis, respiratory insufficiency (18%), two early reoperations, six cardiac complications, one case of gastrointestinal bleeding, and one stroke. In the follow-up period (mean duration, 39.2 months), survival has been 73%, and no additional patients have required dialysis. Conclusions. Although significant perioperative morbidity exists in this high risk population, the long-term preservation of renal function and improvement in hypertension make solitary renal revascularization worthwhile. (Surgery 1996;120:732–737.)