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Salvage by Vascular Reconstruction

James R. Elmore, MD; Ferris S. Ray, MD; Richard C. Dillihunt, MD; William E. Herbert, MD

Arch Surg. 1988;123(5):610-613.

Abstract
• 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 µmol/L (1.8 mg/dL) and one of the following angiographic findings: (1) severe (75%) bilateral occlusions, (2) total occlusion with severe (75%) contralateral occlusion, or (3) solitary kidney with severe (75%) occlusion. Thirty patients met these criteria and underwent revascularization. Six required simultaneous aortic reconstruction. The average creatinine concentration on admission was 310 µmol/L (3.55 mg/dL); this had a statistically significant improvement to 210 µmol/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 µmol/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.

(Arch Surg 1988;123:610-613)

Author Affiliations
From the Department of Surgery, Maine Medical Center, Portland.

Footnotes
Accepted for publication Jan 4, 1988.

Read before the Annual Meeting of the New England Surgical Society, Bretton Woods, NH, Sept 12, 1987.

Reprint requests to Department of Surgery, Maine Medical Center, 22 Bramhall St, Portland, ME 04102 (Dr Elmore).

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