Simultaneous Aortic Reconstruction and Bilateral Renal Revascularization: Is This a Safe and Effective Procedure?

O’Mara, Charles S.; Maples, Michael D.; Kilgore, Thomas L.; McMullan, Martin H.; Tyler, Henry B.; Mundinger, Gerhard H.; Kennedy, Ronald E.

doi:10.1016/s0022-5347(17)41375-9

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…This takes two major forms: (1) angioplastic reconstruction to bypass the stenosis with synthetic or autologous grafts or, in the case of short lesions, excision and direct aortorenal anastomosis; (2) autotransplantation of one or both kidneys. Simultaneous bypass of the diseased aorta is feasible, carries a relatively low operative risk and should be considered in children with a narrowed abdominal aorta at or above the takeoff of the renal arteries [7,8,[62][63][64][65]. Nephrectomy is an alternative to revascularization if one kidney is both markedly smaller than age-appropriate ultrasonographic standards [66] and contributes less than 10% of renal function.…”

Section: Percutaneous Transluminal Angioplasty Compared Withmentioning

confidence: 99%

Evaluation and management of bilateral renal artery stenosis in children: A case series and review

et al. 1995

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This report describes the clinical course, diagnostic evaluation and management of six children with bilateral renal artery stenosis (RAS) and concurrent narrowing of the abdominal aorta. Except for one child with active arteritis, the others were asymptomatic. There were no clinical or laboratory features suggesting the etiology of hypertension in four of six patients, and diagnostic procedures, including Doppler duplex ultrasound and captopril scintigraphy, were unreliable in screening for such hypertension. Abdominal aortography and selective renal angiography confirmed the diagnosis of bilateral RAS and associated anatomical alterations of the aorta and its branches. The hypertension was severe and minimally responsive to antihypertensive agents. It was cured or improved after percutaneous transluminal angioplasty (PTA) of three vessels in two children with mid-vessel stenoses, while hypertension persisted after PTA of two mid-vessel stenoses in a third child and one vessel with ostium stenosis in a fourth child. Autotransplantation of seven kidneys in four children resulted in cure of significant improvement of the hypertension. Renal function was preserved in all children during a mean follow-up time of 41 months. Based on illustrative data from these six children, as well as information from a review of the literature, this report discusses the key diagnostic issues and stresses the potential advantages of renal autotransplantation in selected children with this disorder.

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Section: Percutaneous Transluminal Angioplasty Compared Withmentioning

confidence: 99%

Evaluation and management of bilateral renal artery stenosis in children: A case series and review

et al. 1995

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“…Dialysis eventually became necessary in 5% of patients (21/412), and the crude late mortality rate varied widely from 5% to nearly 40%. Although operative mortality was substantially higher for bilateral RA revascularization in some of the cited reports, 1,9 O'Mara et al 10 were able to perform 32 bilateral procedures with only a single death (3%). Despite a mean preoperative S Cr of 3.1 mg/dL in their series, Chaikof et al 14 also had only one early death (2%).…”

Section: Discussionmentioning

confidence: 93%

Simultaneous aortic replacement and renal artery revascularization: The influence of preoperative renal function on early risk and late outcome

Tsoukas¹,

Hertzer²,

Mascha³

et al. 2001

Journal of Vascular Surgery

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“…10 In addition, the majority opinion is clearly that in a typical patient who requires aortic reconstruction the addition of simultaneous renal artery repair results in overall increased perioperative morbidity rates. [11][12][13][14][15] Given that the majority of patients are likely to have significant comorbidities that at least somewhat increase operative risk for simultaneous renal artery repair, one must carefully evaluate the merits of combining aortic reconstruction with renal artery repair for asymptomatic or perhaps minimally symptomatic renal artery stenosis.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic repair of renal artery stenosis is not justified in patients who require infrarenal aortic reconstruction

Williamson

Abou-Zamzam

Moneta

et al. 1998

Journal of Vascular Surgery

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High-grade ARAS in patients who are undergoing infrarenal aortic reconstruction is associated at late follow-up with increased systolic blood pressure and a need for increased numbers of antihypertensive medications, but not decreased survival rate, dialysis dependence, or an increase in serum creatinine level. These data do not support renal artery repair in patients with ARAS who undergo infrarenal aortic reconstruction.

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Simultaneous Aortic Reconstruction and Bilateral Renal Revascularization: Is This a Safe and Effective Procedure?

Cited by 4 publications

References 3 publications

Evaluation and management of bilateral renal artery stenosis in children: A case series and review

Evaluation and management of bilateral renal artery stenosis in children: A case series and review

Simultaneous aortic replacement and renal artery revascularization: The influence of preoperative renal function on early risk and late outcome

Prophylactic repair of renal artery stenosis is not justified in patients who require infrarenal aortic reconstruction

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