PS68. Surgery for Renovascular Disease: Long-Term Follow-up of Patients Operated on during Fifteen Years

Abstract

Objectives: To investigate the early and long-term outcome after surgery for renovascular disease with emphasis on blood pressure control, renal function and survival. Methods: During the 15-year period 1993-2007, a total of 40 patients underwent open surgery for renovascular disease at our institution. The patients were followed for up to five years with respect to postoperative morbidity, including nephrectomy, dialysis dependency, vessel patency, blood pressure (BP) and renal function. Survival was evaluated by cross-matching all patients with the population-registry on Oct 1 2010. Results: Of the 40 patients, 31 had renal artery stenosis, eight due to fibromuscular dysplasia (FMD), and 23 with predominantly atherosclerotic etiology (ARAS). Nine were operated on for renal artery aneurysm (RAA). 16 of 23 patients with ARAS, 6/8 with FMD and 3/9 with RAA were women. More than 2/3 of ARAS patients needed 3 or more antihypertensive drugs, as did 2/3 of FMD patients prior to surgery. The majority of FMD and RAA patients had normal renal function, in 2/3 of ARAS patients it was impaired. In FMD and RAA patients the disease involved the right renal artery more often, whereas in ARAS patients the disease was evenly distributed. In ARAS and FMD patients, BP at 1 month and 1 year had decreased postcompared to preoperatively, as had the need for antihypertensive medication. No change in renal function was observed. During follow-up, three patients underwent PTRA for re-stenosis. Thirty-day mortality was 2.5%, caused by bowel ischemia in one ARAS patient. Overall five-year survival was 87%. There was one late death among FMD patients, 14 years after surgery. All RAA patients were still alive. In ARAS patients five-year survival was 78%. Median follow-up was 8.5 years. Conclusions: Surgery for renovascular disease can be performed with low morbidity and mortality, as well as a very low need of re-interventions, and should still be considered as a therapeutic option in patients with complex renovascular disease.