Renal Revascularization for Uremia

Abstract

Renal revascularization for uremia has achieved variable success and remains a controversial procedure. The authors retrospectively reviewed their experience with renal revascularization to assess operative morbidity and mortality and to quantify its long-term, beneficial effects on renal function. From 1974 to 1993, 15 patients with renal artery occlusive disease and varying degrees of uremia underwent renal artery revascularization. A retrospective review was conducted of these patients. There were 9 men and 6 women with an average age of 61.5 years (range forty-five to eighty-three years). Preoperative serum creatinine ranged from 1.9 to 10 mg/dL with a mean of 5.07 mg/dL. Three groups were identified: Group A-creatinine 1.9-3.4 mg/dL, Group B-creatinine 3.5-5.2 mg/dL, Group C-patients receiving dialysis. Ten of 15 patients had a solitary kidney. Ten of 15 patients had concomitant aortic reconstruction with renal artery bypass. The mean creatinine went from 5.07 mg/dL preoperatively to 2.22 mg/dL on discharge (P = 0.006).

At late follow up (mean 69.1 months) the mean creatinine was 2.62 mg/dL. Late (mean 69.1 months) functional results indicated that 13 of 15 patients (87%) had improved or stabilized renal function. Five of 7 patients who were receiving dialysis preoperatively required no postoperative dialysis because of improvements in renal function. One patient eventually required dialysis although he had not required it preoperatively. There were no operative deaths, but 2 major complications occurred. Mean survival time was one hundred seven months with 80% survival at five years and 60% survival at ten years. On average 63.6 months of dialysis-free survival were noted for the group. Renal revascularization for uremia can be performed with low morbidity and mortality. Long-term follow up indicates a low mortality and a lasting beneficial effect on renal function in the majority of patients. Additionally, this beneficial effect is recognized in patients already receiving preoperative dialysis.