SAFETY AND EFFICACY OF TRANSAORTIC RENAL ENDARTERECTOMY AS AN ADJUNCT TO AORTIC-SURGERY

被引:37
作者
CLAIR, DG
BELKIN, M
WHITTEMORE, AD
MANNICK, JA
DONALDSON, MC
机构
[1] BRIGHAM & WOMENS HOSP, DEPT SURG, DIV VASC SURG, BOSTON, MA 02115 USA
[2] MALCOLM GROW MED CTR, DEPT SURG, WASHINGTON, DC USA
关键词
D O I
10.1016/S0741-5214(95)70220-2
中图分类号
R61 [外科手术学];
学科分类号
摘要
Purpose: A study was undertaken to assess the safety and efficacy of transaortic endarterectomy for orificial atherosclerotic renovascular disease (ASRD), particularly in conjunction with surgery for concomitant aortic disease. Methods: Forty-three consecutive patients with ASRD treated with transaortic orificial eversion endarterectomy were studied retrospectively to identify surgical indications, technical features, operative morbidity and mortality rates, and efficacy. Results: A total of 76 renal arteries underwent transaortic endarterectomy for hypertension (88% of patients) or serum creatinine of 1.5 mg/dl or greater (65% of patients), including two patients undergoing dialysis. Concomitant aortic surgery was performed in 39 patients for aneurysmal (n = 30) or occlusive (n = 9) disease. Two (2.6%) of 76 renal endarterectomies required intraoperative conversion to bypass because of poor flow, and three arteries (3.9%) were reimplanted or bypassed because of fragility of the renal orifice after endarterectomy. Thirty-day operative death occurred in two patients (4.7%), and major morbidity occurred in six (14.0%). Hypertension was cured or improved in 83% of patients with hypertension. Among patients with preoperative renal insufficiency, function was improved in 19%, with dialysis discontinued in one of two patients receiving dialysis, and function was worse in 23%, with one patient dependent on dialysis. Conclusion: Transaortic renal endarterectomy is an acceptably safe and effective adjunctive technique in selected patients with combined aortic disease and ASRD.
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页码:926 / 934
页数:9
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