Renal Failure and Advanced Atherosclerotic Lesions

Elmore, James R.; Ray, Ferris S.; Dillihunt, Richard C.; Herbert, William E.

doi:10.1001/archsurg.1988.01400290096016

Cited by 22 publications

(2 citation statements)

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“…Moreover the acute increase in afterload from aortic cross-clamping may have harmful effects on the left ventricle whose performance is often already limited by coronary artery atherosclerosis. 24 Thus we and others attempt to avoid manipulating or crossclamping the aorta in these patients if at all possible, t t, 19,25,26 On the other hand, inone quarter of our patients aneurysmal or occlusive atherosclerosis was sufficiently severe to require aortic replacement. Replacing the aorta at the time of renal revascularization substantially increases the morbidity of the operation as illustrated by our two deaths in the patients undergoing combined procedures.…”

Section: Discussionmentioning

confidence: 85%

“…In earlier experience from MMC after operation seven of eight patients with atherosclerosis who required hemodialysis in long-term follow-up died within 1 year of beginning dialysis. 19 In a much larger series Mailloux et al2s reported an 88% 5-year mortality rate in the patients with atherosclerosis requiring chronic hemodialysis. This justifies operative intervention even in the presence of significant risks.…”

Section: Discussionmentioning

confidence: 95%

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Changing patterns in surgery for chronic renal artery occlusive diseases

Bredenberg¹,

Sampson²,

Ray³

et al. 1992

Journal of Vascular Surgery

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We report 66 patients undergoing 69 operations for chronic renal artery occlusive diseases operated on at two institutions between January 1985 and June 1990. Etiology was atherosclerosis in 59 patients (90%); fibromuscular disease in four (6%), and three children with nonfibromuscular disease stenosis (4%). Atherosclerosis was local in 10 and generalized in 49 (83% of all patients). Fifty operations (72%) were for salvage of renal function. Average serum creatinine was 2.3 mg/dl and was elevated in 46 patients (70%). Donor arteries for reconstruction were aorta 20 (29%), aortic graft 16 (23%), and other abdominal arteries 33 (48%). Twenty-one patients had concomitant vascular procedures including 16 aortic replacements. The two operative deaths (3%) followed aortic replacements. Three grafts (4%) occluded before discharge from the hospital. Eighty-six percent of patients undergoing renal salvage avoided long-term dialysis. In past decades fibromuscular disease and localized atherosclerosis were the most frequent renal artery occlusive diseases undergoing surgery, hypertension was the predominant indication, and the most frequent operation was aortorenal bypass. As a result of improved pharmacologic management of hypertension and the development of percutaneous transluminal dilation, most patients in this series had far advanced generalized atherosclerosis, and renal salvage was the most frequent indication for operation. As a consequence of the severity of the atherosclerosis, 48% of operations avoided the aorta, 23% replaced the aorta, and aortorenal bypass was used in only 29%.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 95%