MP79-08 SURGICAL MANAGEMENT OF RENAL ARTERY STENOSIS DUE TO TAKAYASU'S AORTOARTERITIS:RESULTS FROM A TERTIARY CARE CENTER IN SOUTH INDIA

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2015MP79-08 SURGICAL MANAGEMENT OF RENAL ARTERY STENOSIS DUE TO TAKAYASU'S AORTOARTERITIS:RESULTS FROM A TERTIARY CARE CENTER IN SOUTH INDIA John S. Banerji, Antony Devasia, Nitin S. Kekre, Ninan K. Chacko, and Ganesh Gopalakrishnan John S. BanerjiJohn S. Banerji More articles by this author , Antony DevasiaAntony Devasia More articles by this author , Nitin S. KekreNitin S. Kekre More articles by this author , Ninan K. ChackoNinan K. Chacko More articles by this author , and Ganesh GopalakrishnanGanesh Gopalakrishnan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2865AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Takayasu's arteritis is a rare disease with significant morbidity amongst young patients, with a predilection to involve renal vasculature. As literature regarding long term outcome is sparse, we decided to elucidate our experience with treatment for renal artery stenosis in this group. METHODS After institutional review board clearance, electronic records were reviewed retrospectively. Patients with renal artery stenosis, secondary to Takayasu's arteritis, as diagnosed by American College of Rheumatology criteria (1990) were included, over a 10 year period (2000- 2010). Data on presentation, antihypertensive usage, renal function and intra and post operative complications were described. RESULTS There were 48 patients with renal artery stenosis, during the 10 year period, with a female preponderance (F: M =7:1). Mean ages were 27 years in female patients and 33.7 years in males. Unilateral renal artery stenosis was present in 8 subjects; the rest had bilateral disease. All had hypertension, and 72% (35/48) presented with headache as the predominant symptom. More than half (54%; 26/48) had fever. Clinically audible renal bruit was present in less than 10% (4/48). At presentation, 6 patients had creatinine levels more than 2 mg % (Range 2-4.5 mg %). Inflammatory markers viz. Erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) were elevated in 79% (38/48) and 91% (32/35) respectively. Angiogram revealed aortic arch involvement in 88% (37/42), with aorta and renal vessels involved in isolation in 5. Prior angioplasty with stenting was performed in 8 patients, with 2 failures. 10 patients underwent nephrectomy. 38 underwent renal auto transplantation, with bench surgery in 4 who had multiple vessels and technically demanding renal vasculature. The mean renal size was 8.8 cm. Perioperative complications included post op haemorrhage (5/48), and thrombosis of graft in 1 patient, leading to graft loss. One patient developed abdominal compartment syndrome leading to small bowel gangrene and death. Follow up was available for 38 of the 48 patients. The average follow up was 48 months. In the group with elevated creatinine (>2 mg %), all but one had a significant fall in creatinine. Inflammatory markers returned to normal in a majority of the patients. There was a decreased need for antihypertensive in 78% (30/38). CONCLUSIONS Renal revascularization helps in preserving renal function in patients with Aortoarteritis. There is an appreciable decrease in the use of antihypertensives with revascularization. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1013 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information John S. Banerji More articles by this author Antony Devasia More articles by this author Nitin S. Kekre More articles by this author Ninan K. Chacko More articles by this author Ganesh Gopalakrishnan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...