Lesions of the renal artery: Surgical technic and results

Abstract

1. 1. An analysis is presented of our experience during the past five years with 225 hypertensive patients having occlusive lesions of the renal arteries in whom some type of vascular surgical procedure designed to restore normal circulation to the kidneys was performed. 2. 2. Atherosclerosis was the most common etiologic basis for the occlusive process, accounting for 83 per cent of the patients. The next most common type of occlusive lesion was fibromuscular hyperplasia, occurring in 13 per cent of the patients. In the remaining patients the lesions were the result of aneurysms of the renal arteries and an unusual form of coarctation of the abdominal aorta in the region of the origin of the renal arteries. 3. 3. The occlusive process involved the main renal arteries in 90 per cent and an accessory renal artery in 10 per cent of the patients. Bilateral involvement was present in 30 per cent. 4. 4. Associated diseases of the abdominal aorta in the form of aneurysms or occlusive lesions requiring simultaneous surgical treatment were present in 30 per cent of these patients. 5. 5. The age distribution of these patients ranged from eight to seventy-two years, with 82 per cent being in the third through seventh decades of life. The male sex predominated in a ratio of about 2:1. In the group with fibro-muscular hyperplasia, however, the female sex predominated in a ratio of about 5:1. 6. 6. The duration of hypertension was less than two years in 42 per cent and more than five years in 33 per cent of the patients. The onset of hypertension was symptomatic in 60 per cent. 7. 7. Although various screening methods were employed in the study of these patients and found to be useful, the most reliable definitive diagnostic procedure has been found to be arteriography. In this connection determination of a pressure gradient across the lesion by intra-arterial blood pressure measurements during operation has been found to be particularly significant. 8. 8. Several surgical principles with certain technical variations designed to overcome the occlusive process in the renal arteries and to restore normal circulation to the kidneys may be employed, depending upon the type, location and extent of the lesion and upon associated diseases of the abdominal aorta. Among these the three most commonly employed are endarterectomy, patch graft angioplasty and the bypass procedure. 9. 9. The results of operation in this series have been quite gratifying. Followup studies ranging up to five years, with an average of about two years, have been made on all patients. Blood pressure has been restored to normal in 81 per cent of the patients. In 8 per cent a significant lowering of diastolic blood pressure. The total mortality, including both operative and subsequent deaths, was 5.8 per cent.