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

Abstract

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.

Contemporary Management of Splanchnic and Renal Artery Aneurysms: Results of Endovascular Compared with Open Surgery from Two European Vascular Centers

“…In the series in which the mid-term or long-term patency rates after open procedures were reported, 89.2%e100% of vascular reconstructions remained patent after a mean follow-up of 17.8e91 months. 4,6,8,9,13,16,18,20,23 In the endovascular group, of the 241 patients assessed for SRAA reperfusion during a mean follow-up of 10e78 months, aneurysm sac reperfusion was seen in nineteen patients (7.9%). In our series, two patients presented with reperfusion at 2 years and 6 months respectively.…”

A LIFE IN UROLOGY: Privilege, Obligation and Reward

“…Development of onestage hypospadias repair (OU) was addressed as ACU lecture on the occasion of 2018 JUA/UAA meeting [23]. The experience in renovacular and renal surgery was presented [24,25] and addressed as a presidential lecture at JUA meeting in 2000 [26]. Along with reconstructive surgery in kidney transplantation of children [27] stressed that these are the new fields to be tackled by the next generation to make urology a true discipline of surgery.…”

Pre- and postcaptopril renal scintigraphy as a screening test for renovascular hypertension in children

“…However, it is invasive and requires hospitalization and usually general anesthesia in children [6]. Renal scintigraphy before and after the administration of captopril is a noninvasive method used to diagnose RVH and has been used as a screening test to select patients for DSA [7][8][9][10]. DMSA and MAG3 scans evaluate perfusion of the kidney and renal function and can identify parts of the kidney that have reduced function.…”

“…The administration of an angiotensinconverting enzyme inhibitor (ACEI) can impair the blood flow to one or both kidneys or a part of a kidney. This can be visualized on the postcaptopril isotope study [6][7][8][9][10]. The aim of this study was to assess the accuracy of pre-and postisotope studies in detecting children with RVH.…”