Prophylactic repair of renal artery stenosis is not justified in patients who require infrarenal aortic reconstruction

Abstract

Purpose: Simultaneous prophylactic repair of asymptomatic renal artery stenosis (ARAS) in patients who require infrarenal aortoiliac reconstruction is controversial. This study documents the natural history of ARAS in patients who require aortic reconstruction. Methods: Two hundred patients who required aortic reconstruction from 1985 to 1990 for indications other than hypertension or renal salvage were identified. ARAS was not repaired. Preoperative angiograms were available for 171 of 200 patients and were reviewed for renal artery stenosis. Patients were assessed for atherosclerotic risk factors, survival, preoperative and follow-up blood pressure, serum creatinine level, antihypertensive medication usage, and need for dialysis. Results: The mean duration of follow-up was 6.3 years. Twenty-four of 171 patients (14%) had preoperative unilateral 70% to 99% diameter reduction ARAS, and eight (5%) had bilateral 70% to 99% ARAS. Clinical features associated with ≥70% ARAS included coronary artery disease, increased age, and a diagnosis of hypertension ( p < 0.05). Patients with ≥70% ARAS did not have a decreased 7-year survival rate (66% vs 84%; p = 0.10) but had higher systolic blood pressures (153 ± 25 vs 138 ± 30 mm Hg; p < 0.05) as well as increased numbers of antihypertensive medications at follow-up (1.1 ± 0.2 vs 0.7 ± 1; p < 0.05). The mean serum creatinine level (1.1 ± 0.3 preoperative vs 1.4 ± 0.8 mg/dl; p = NS) was not increased. One patient (0.58%) with polycystic kidney disease and minimal renal artery stenosis required dialysis. Conclusions: High-grade ARAS in patients who are undergoing infrarenal aortic reconstruction is associated at late follow-up with increased systolic blood pressure and a need for increased numbers of antihypertensive medications, but not decreased survival rate, dialysis dependence, or an increase in serum creatinine level. These data do not support renal artery repair in patients with ARAS who undergo infrarenal aortic reconstruction. (J Vasc Surg 1998;28:14-22.)