Long-term results after surgical reconstruction for renal artery fibromuscular dysplasia

Objectives: to study the initial and long-term results of surgery for renal artery fibromuscular dysplasia ((RFMD). Patients and Methods: all patients undergoing renal artery reconstruction (RAX) performed for RFMD between January 1980 and December 1997, were studied. The preprocedural and postprocedural clinical records of 101 patients (80 women, 21 men; mean age at surgery 43 years) were retrospectively reviewed. All surviving patients were invited fbr clinical reexamination and colour-coded duplex-ultrasound of the renal arteries (RA). Results: initial technical success was achieved in 83 of 93 patients (89%), in whom postoperative angiography (90) or renal scintigraphy (three) were performed for assessment of RAX. Early occlusion (four) or stenosis tone) demanded reoperation in five patients (5%). The 30-day mortality and morbidity were 2% and 12% for the entire group. Primary patency rate tons 74% at 5 years, Fifteen patients had to be reoperated for restenosis after a mean time of 33 months, resulting in a secondary patency rate of 85% after 5 years. In 61 patients with patent RAX at the time of re-examination, arterial hypertension was cured only in 22 (36%) and improvement in 19 (31%). Conclusion: vascular surgery for RFMD yields good long-term results as to kidney perfusion and function. Surveillance of RAR-patency by means of ultrasound examination is mandatory in case of recurrence of arterial hypertension or deterioration. Rates of dire of hypertension are disappointing.