Aortic and Renal Vascular Disease

Abstract

Assessment of the predictive value of preoperative factors in the determination of operative risk in 50 patients who underwent simultaneous aortic and renovascular procedures over a 10-year period is reported. There were six operative mortalities (12%). Factors associated with increased mortal risk were azotemia (43% vs. 7%), associated complex renal or visceral procedures (31% vs. 5%), treatment of aortic aneurysm vs. occlusive disease (17% vs. 5%), positive EKG (19% vs. 4%), age over 60 years (20% vs. 4%), and a history of diffuse peripheral vascular disease (18% vs. 7%). None of these differences, by themselves, had statistical significance. Through discriminate analysis with assignment of weighted scores to the five most powerful predictors of operative death (complex procedure--4, azotemia--4, aortic aneurysm repair--3, positive electrocardiogram--2, history of diffuse vascular disease--2), a weighted score of greater than or equal to 10 predicted operative death with an 83% sensitivity and 93% specificity (p = 0.003). Although advanced age, diabetes, severity of hypertension, and history of heart disease were associated with increased operative risk, they contributed minimal discriminate value to that provided by the preceding five variables. This was because these weaker risk factors were usually found in association with the predictors in the discriminant score. This study suggests that in patients with high weighted discriminant scores (greater than or equal to 10), consideration of operative risk is particularly important in evaluation of the proposed value of combined procedures.

Successful Renal Autotrans-plantation with Y-Prosthetic Aortic Replacement in a Patient with Complete Occlusion of Abdominal Aorta and Renal Artery

“…Generalized atherosclerosis is often associated with hypertension, deterioration of the renal function, cardiac decompensation, limb-threatening ischemia, and, rarely, intestinal angina [1][2][3]. And atherosclerosis and throm botic occlusion of the abdominal aorta represent the end stage of an atherosclerotic process.…”

“…Gill et al [7] and Shahian et al [8] reported an increased operative risk of prosthetic replacement of the abdominal aorta with renal revascular ization and the usefulness of extra-anatomic technique of renal revascularization, and Dean et al [2] noted the risk factors involving myocardial ischemia: a serum creatinine level >3.0 mg/dl and diffuse peripheral vascular disease. Though the patient had these risk factors, the operation involving aortic replacement and renal autotransplanta tion have yielded satisfactory long-term results.…”

“…Abdominal aortic occlusion occurs infrequently, however, and often is associated with stenosis of a visceral artery such as renal artery, superior or inferior mesenteric artery, or celiac artery [1][2][3]. The patency of a renal revascularization is occasionally compromised by proximal extension of an intraluminal aortic thrombus, resulting in renal failure and hypertension.…”