PMID- 12563198
OWN - NLM
STAT- MEDLINE
DCOM- 20030225
LR  - 20221109
IS  - 0741-5214 (Print)
IS  - 0741-5214 (Linking)
VI  - 37
IP  - 2
DP  - 2003 Feb
TI  - Reconstruction for renal artery aneurysm: operative techniques and long-term 
      results.
PG  - 293-300
AB  - BACKGROUND: Ninety-four patients (37 male, 57 female; mean age, 51.0 years) 
      underwent reconstruction for renal artery aneurysm (RAA) between 1980 and 2001. 
      RAAs were present in 52 patients in the right kidney, in 29 patients in the left 
      kidney, and in 13 patients in both kidneys. Eighty-three aneurysms were located 
      in the mainstem, 49 in a branch artery, and four in an accessory artery. 
      Additional ipsilateral renal artery stenoses (RAS) occurred in 26 patients, 
      bilateral RAS in 18, and contralateral RAS in six. The causes of RAA were 
      fibromuscular dysplasia (n = 48), atherosclerosis (n = 28), dissection (n = 7), 
      aortic coarctation (n = 5), arteritis (n = 3), giant cell arteritis (n = 1), 
      Marfan's syndrome (n = 1), and trauma (n = 1). Seventy-five patients had 
      hypertension, 14 were asymptomatic, and five had rupture. Indications for RAA 
      repair concerned aneurysms with 1 cm or more diameter in combination with risk 
      factors of hypertension, ipsilateral and contralateral stenosis, and childbearing 
      age in women. Without risk factors, aneurysm size eligible for reconstruction was 
      limited to 2 cm or more. METHODS: Methods applied for reconstruction in 107 
      kidneys and 136 aneurysms included aneurysm resection with tailoring (n = 37), 
      saphenous vein graft interposition (n = 40), tailoring and saphenous vein graft 
      interposition (n = 7), resection and reanastomosis (n = 14), saphenous vein graft 
      interposition and resection and reanastomosis (n = 3), polytetrafluoroethylene 
      bypass (n = 5), and homologous vein graft interposition (n = 1). Four 
      reconstructions had to be performed ex situ because of multiple branch 
      involvement in three patients and rupture in one. In all patients, the concerned 
      kidney was protected with hypothermic flush perfusion with addition of heparin 
      and prostaglandin E1. RESULTS: The overall morbidity rate was 17%, including one 
      early graft occlusion, one partial thrombosis of the renal artery that 
      necessitated fibrinolytic therapy, and a branch artery stenosis after tailoring 
      managed with aortorenal bypass. The mortality in elective cases was null; one 
      patient died of myocardial infarction 2 days after an emergency operation for 
      ruptured RAA. The technical primary success rate was 96.8%; the secondary success 
      rate was 98.9%. After a follow-up period from 1 to 143 months (mean, 46 months) 
      in 83 patients (88%), 67 (81%) had patent renal arteries free of stenoses. Among 
      six patients with RAS, four underwent successful reoperation, five had mainstem 
      occlusions, three had segmental artery occlusions, and two underwent nephrectomy. 
      Concerning the patients who underwent reoperation, percutaneous transluminal 
      angioplasty was considered seriously but assessed as inappropriate because of 
      long extension of stenosis or involvement of branch arteries. Hypertension was 
      cured in 19 patients (25%) and improved in 17 (22%). CONCLUSION: Surgical 
      reconstruction of RAA is a safe procedure that provides good long-term results, 
      prevents aneurysm rupture, cures or improves hypertension in about half of the 
      cases, and can be achieved with autogenous reconstruction in 96%.
FAU - Pfeiffer, Tomas
AU  - Pfeiffer T
AD  - Departments of Vascular Surgery and Kidney Transplantation, University Hospital, 
      Heinrich-Heine-University, Dusseldorf, Germany. tomas.pfeiffer@uni-duesseldorf.de
FAU - Reiher, Lutz
AU  - Reiher L
FAU - Grabitz, Klaus
AU  - Grabitz K
FAU - Grunhage, Benjamin
AU  - Grunhage B
FAU - Hafele, Sebastian
AU  - Hafele S
FAU - Voiculescu, Adina
AU  - Voiculescu A
FAU - Furst, Gunter
AU  - Furst G
FAU - Sandmann, Wilhelm
AU  - Sandmann W
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aneurysm/complications/diagnostic imaging/*surgery
MH  - Aneurysm, Ruptured/diagnostic imaging/etiology/*prevention & control
MH  - Female
MH  - Humans
MH  - Hypertension, Renovascular/diagnostic imaging/etiology/*prevention & control
MH  - Male
MH  - Middle Aged
MH  - Outcome Assessment, Health Care
MH  - *Postoperative Complications
MH  - Radiography
MH  - Renal Artery/diagnostic imaging/*surgery
MH  - Retrospective Studies
MH  - Time Factors
MH  - Vascular Surgical Procedures/adverse effects/*methods
EDAT- 2003/02/04 04:00
MHDA- 2003/02/26 04:00
CRDT- 2003/02/04 04:00
PHST- 2003/02/04 04:00 [pubmed]
PHST- 2003/02/26 04:00 [medline]
PHST- 2003/02/04 04:00 [entrez]
AID - S0741521402752580 [pii]
AID - 10.1067/mva.2003.117 [doi]
PST - ppublish
SO  - J Vasc Surg. 2003 Feb;37(2):293-300. doi: 10.1067/mva.2003.117.