Renal failure and advanced atherosclerotic lesions. Salvage by vascular reconstruction

J. R. Elmore, F. S. Ray, R. C. Dillihunt and W. E. Herbert
Department of Surgery, Maine Medical Center, Portland 04102.

Occlusive renal artery lesions and progressive renal failure have a dismal prognosis if not treated. We analyzed our results to determine if the risks of renal vascularization were justified based on the final outcome in such patients. Inclusion criteria were a creatinine concentration of at least 160 mumol/L (1.8 mg/dL) and one of the following angiographic findings: (1) severe (greater than or equal to 75%) bilateral occlusions, (2) total occlusion with severe (greater than or equal to 75%) contralateral occlusion, or (3) solitary kidney with severe (greater than or equal to 75%) occlusion. Thirty patients met these criteria and underwent revascularization. Six required simultaneous aortic reconstruction. The average creatinine concentration on admission was 310 mumol/L (3.55 mg/dL); this had a statistically significant improvement to 210 mumol/L (2.41 mg/dL) at discharge. There was one perioperative death (3.3%). Initially, 22 patients had improved function (creatinine concentrations 20% lower), and seven patients had stable creatinine values. Eight patients ultimately required long-term dialysis. In the remaining 21 patients, with an average follow-up of 32 months, the average creatinine concentration was 220 mumol/L (2.51 mg/dL), still a significant improvement. Thus, we have demonstrated the relative safety and benefit of operating on these high-risk patients.