Impact of incidental renal artery stenosis on long-term mortality in patients with peripheral arterial disease undergoing vascular procedure

• Published in: Journal of vascular surgery Vol. 54; no. 3; pp. 785 - 790
• Main Authors: Mui, Kwok-Wai, MD, Zeebregts, Clark J., MD, PhD, van den Hout, Huib, MD, van Baal, Jef G., MD, PhD, Navis, Gerjan, MD, PhD, Jan-Woittiez, Arend, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2011; Elsevier
• Subjects: Aged; Angiography, Digital Subtraction; Biological and medical sciences; Chi-Square Distribution; Female; Humans; Incidental Findings; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Netherlands; Neurology; Patient Selection; Peripheral Arterial Disease - complications; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - mortality; Peripheral Arterial Disease - surgery; Predictive Value of Tests; Proportional Hazards Models; Renal Artery Obstruction - complications; Renal Artery Obstruction - diagnostic imaging; Renal Artery Obstruction - mortality; Retrospective Studies; Risk Assessment; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; Arterial disease; Vascular disease; Kidney disease; Human; Urinary system disease; Surgery; Mortality; Occlusive arterial disease; Cardiovascular disease; Renal artery stenosis; Renal artery disease
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2011.03.251

Objective In peripheral arterial disease (PAD), mortality is high. Incidental renal artery stenosis (RAS) is a predictor of mortality in PAD patients undergoing angiography. This might be relevant for risk-benefit assessment when vascular surgery is considered, both in terms of perioperative risk, and in terms of life expectancy. Methods We studied the prognostic impact of incidental RAS in 488 subjects (334 men, 154 women; mean follow-up 6.0 ± 3.4 years) who underwent angiography for PAD in a single center between 1997 and 2000. Renal arteries were visualized and follow-up data concerning vascular procedures were analyzed. Results RAS (diameter reduction >50%) was present in 26%. Forty-six percent of study patients underwent a vascular procedure (85% vascular surgery, remainder underwent amputation). Patients that underwent vascular surgery had a better renal function at baseline, less history of stroke, and a larger proportion of smokers. Overall mortality was similar for patients that underwent surgery (54.5%) and those without surgery (49.6%). There was no difference in 90-day postoperative mortality for patients without or with RAS (7.2% vs 10.3%; NS). For subjects that underwent bypass surgery, long-term mortality was substantially and significantly higher among those with RAS (65.1%) vs those without RAS (43.5%). On Cox regression analysis, age was the only independent predictor of 90-day postoperative mortality. The well-known cardiovascular risk factors of age, diabetes mellitus, history of prior peripheral vascular disease, smoking, prior myocardial infarction, prior stroke, and amputation, as well as presence of RAS, were independent predictors for overall mortality. Conclusion In PAD, incidental RAS predicts long-term mortality independent of other risk factors. The elevated mortality is not due to a higher postoperative risk. Subjects presenting with PAD and RAS can therefore undergo vascular procedures with the same risk as other patients.