Bilateral renal artery atherosclerosis - The results of surgical treatment

Objectives: To assess the outcome of surgical treatment for severe bilateral venal artery stenosis. Design: Non-randomised, prospective, consecutive series. Materials: Twenty-five patients undergoing surgical reconstruction of whom 14 required aortic replacement (aneurysm, n = 7, severe claudication, n = 7). In 22 patients, the principle aim of treatment was preservation or salvage of venal function whilst three patients had intractable hypertension. Methods: Serum creatinine and blood pressure were measured at the most recent follow-up (minimum 6 months, median 17 months) and compared to preoperative values. Results: Renal function (serum creatinine) improved or stabilised in 16 of 18 patients in whom if was elevated preoperatively (> 140 mu mol/l; 3 patients on dialysis) whilst one patient with early graft occlusion subsequently required long term dialysis. Blood pressure control was also improved in 14 patients. There were four postoperative deaths (16%) and five patients required re-exploration for postoperative anuria (3) or bleeding (2). Conclusions: Surgical revascularisation preserves renal function and may improve blood pressure control in patients with advanced multi-system atherosclerosis. The operative morbidity and mortality is significant although historical data suggests that this is less than for similar patients treated medically.