Renal Artery Repair. Consequence of Operative Failures

Hansen, Kimberley J.; Deitch, Jonathan; Oskin, Timothy C.; Ligush, John; Craven, Timothy E.; Dean, Richard H.

doi:10.1097/00005392-199903000-00098

Cited by 16 publications

(28 citation statements)

References 5 publications

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“…Five-year patency following aortorenal bypass is 95.0%, compared to 55.6% for renal artery stenting. 7,10,[18][19][20] The five-year patency was assumed to be similar between patients who had no complications and those who experienced one or more complications. A primary patency of 75% was identified in the literature and used for aortorenal bypass patients who developed complications to determine whether this significantly influenced cost or value for aortorenal bypass compared to renal artery stenting, but none was found (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…Of those patients who had a failed aortorenal bypass, only 18% are dialysis-free at five years. 10 Patients who undergo optimal management through a combination of renal artery stent placement and best medical management have a 64.9% five-year dialysis-free survival. 5,22,23 Specific data on five-year dialysis-free survival are not available for patients who fail renal artery stenting, and values for aortorenal bypass were substituted.…”

Section: Resultsmentioning

confidence: 99%

“…If a future value calculation is completed with the $519,334 improvement, aortorenal bypass is expected to lead to an additional 10 years of dialysis-free survival compared to just 2.4 years for patients who undergo renal artery stenting, similar to what has been previously reported. 5,10,12,19,21,23 …”

Section: Discussionmentioning

confidence: 99%

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Renal artery stenting may not be appropriate for patients with atherosclerotic renal artery stenosis

Dua

Desai²,

Upchurch

et al. 2015

Vascular

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Introduction: This study compared aortorenal bypass to renal artery stenting to determine the most efficacious and financially sound method for treating patients with atherosclerotic renal artery stenosis (RAS). Methods: A decision analysis using direct and indirect costs, and value of statistical life (VSL) was completed. Direct costs were obtained using the Nationwide Inpatient Sample (NIS), indirect costs from the National Institute of Diabetes and Digestive and Kidney Diseases, and VSL from the Department of Transportation. A variance-based sensitivity analysis was completed to assess the accuracy of the decision analysis. Results: Aortorenal bypass has a 95% five-year patency, a 98% 30-day survival, a 26% rate of overall complications, and a 70% five-year dialysis-free survival. Renal artery stenting has a 56% five-year patency, a 99% 30-day survival, a 40% rate of complications, and a 65% five-year dialysis-free survival. Renal artery stenting has an overall cost of $305,370 and aortorenal bypass has an overall cost of $103,453 per patient. After accounting for VSL, renal artery stenting has a negative value of À$182,270 and aortorenal bypass has a value of $415,881. Conclusions: Lower five-year patency and higher rate of complications from renal artery stenting that ultimately lead to significantly lower five-year dialysis-free survival.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Renal artery stenting may not be appropriate for patients with atherosclerotic renal artery stenosis

Dua

Desai²,

Upchurch

et al. 2015

Vascular

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show abstract

“…The left kidney, which in the nephrogram was faintly visible through the extensive collaterals, eventually required nephrectomy. [14]. Secondary SR in such cases may be technically complicated.…”

Section: Case 2: No 5-15mentioning

confidence: 99%

Surgery for Renovascular Diseases: A Single-Center Experience in Revascularizing Renal Artery Stenosis and Aneurysm

et al. 2002

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Objective: Diagnosis and management of renovascular diseases (RVD) at Hokkaido University Hospital was reviewed with particular emphasis on surgical revascularization (SR). Patients and Methods: We studied a total of 33 patients with RVD [16 patients with renal artery stenosis (RAS): group 1, and 17 patients with renal artery aneurysm (RAA): group 2, 10 males, 23 females, aged 9–69 years (median 46), unilateral 24, bilateral 9]. Functional diagnosis of RVD with regard to renovascular hypertension (RVH) was done with the captopril test (CP-T) and captopril-enhanced ^99mTc-DTPA (diethylenetriamine-pentaacetic acid) renal scintigraphy (CER). All were subjected to SR. Number, length, size and site of RVD with involvement of branch arteries dictated the choice of operative method but basically in situ repair for main trunk disease (11 kidneys) and ex vivo bench repair with autotransplantation for those beyond the first bifurcation intrarenally involving branched arteries (24 kidneys) were employed. The outcome was analyzed as to blood pressure control, split renal function, and branch renal artery patency. Results: (1) Sensitivity of CP-T and CER was 79 and 77% respectively in group 1, while it was 40 and 38% respectively in group 2. (2) Blood pressure was cured in 66.7% (group 1, 68.8% and group 2, 63.6%) and improved in 22.2% (group 1, 18.8% and group 2, 27.3%) with an overall success rate of 88.9%. (3) Renal function was good in 81.3% (group 1, 83.3% and group 2, 78.6%) and fair in 9.4% (group 1, 0% and group 2, 21.4%) with overall success in 90.7%. (4) Patency was preserved in 90.5% of branch anastomoses. Conclusions: Despite challenging complexities, SR of RVD is feasible with a reasonable amount of morbidity and effective in controlling blood pressure and preserving renal function in the majority of cases.

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“…In renal transplantation in adults, renal artery reconstruction is often warranted for various reasons; here, a saphenous vein graft (SVG) is the most common conduit used for renal artery reconstruction in adults [2]. Its aneurysmal degeneration is unusual, but when it occurs, secondary procedures are associated with a significant and independent risk of eventual dialysis dependence [2][3][4]. There are scarce data on the treatment of saphenous vein graft (SVG) aneurysms (SVGA) in the existing literature, especially about patients after renal artery reconstruction of a kidney allograft.…”

Section: Introductionmentioning

confidence: 99%

Repair of an Autologous Saphenous Vein Graft Aneurysm Ten Years after Renal Artery Reconstruction during Live Donor Renal Transplantation

Oelschlaeger¹,

Sokolakis²,

Kalogirou³

et al. 2017

Urol Int

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Saphenous vein graft (SVG) aneurysms (SVGA) after renal transplantation represents a rare vascular complication with subsequent challenging multidisciplinary treatment. We present a case of a 30-year-old female who received a live donor kidney transplantation for end-stage renal disease that was caused due to the hemolytic uremic syndrome. Postoperatively, an insufficient graft perfusion due to an arterial kinking was noted and repaired using an autologous SVG interposition. Ten years later, a 3-cm aneurysm of the SVG at the anastomotic site with the common iliac artery was discovered. Multidisciplinary surgical exploration with excision of the aneurysm-carrying vein graft and interposition of a new autologous SVG was successfully carried out with preservation of renal allograft's function. Treatment of SVGA after rental transplantation with a new autologous SVG is challenging but feasible, requiring a multidisciplinary approach in order to guarantee successful rates and to prevent allograft loss.

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Renal Artery Repair. Consequence of Operative Failures

Cited by 16 publications

References 5 publications

Renal artery stenting may not be appropriate for patients with atherosclerotic renal artery stenosis

Renal artery stenting may not be appropriate for patients with atherosclerotic renal artery stenosis

Surgery for Renovascular Diseases: A Single-Center Experience in Revascularizing Renal Artery Stenosis and Aneurysm

Repair of an Autologous Saphenous Vein Graft Aneurysm Ten Years after Renal Artery Reconstruction during Live Donor Renal Transplantation

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