Ex vivo renal artery reconstruction for complex renal artery disease

Objective: The objective of this study was to evaluate long-term outcome of renal revascularization by ex vivo renal artery reconstruction for complex renal artery disease. Methods: From 1987 to 2012, 23 patients (17 women; mean age, 45 years) with complex renal artery lesions underwent open renal revascularization by ex vivo technique. Underlying disease included fibromuscular dysplasia with aneurysm(11), atherosclerotic aneurysm (6), Takayasu arteritis (3), and other (3). Outcomes analyzed included primary, primary assisted, and secondary patency rates; antihypertensive medication requirements; renal function and preservation; and mortality. Late graft patency, renal size, and cortical thickness were analyzed by serial renal duplex ultrasound examinations. Results: Twenty-four kidneys in 23 patients were revascularized by ex vivo renal artery reconstructive techniques. Perioperative complications were limited to two patients requiring reoperation for bleeding. Renal function did not change, and there were no in-hospital deaths. During a mean follow-up of 44 months, a single bypass graft occluded, requiring repeated bypass, which was performed with renal preservation. Primary, primary assisted, and secondary patency rates were 94% at 5 and 10 years. Compared with preoperative values, systolic and diastolic blood pressure and the number of antihypertensive medications were reduced (P <.05) in the 18 patients with hypertension. Late renal function was preserved as measured by no change in both serum creatinine concentration and estimated glomerular filtration rate compared with preintervention values (P =.25 and P =.35, respectively). In addition, there was no difference in treated kidney size or renal cortical thickness on follow-up compared with preoperative measurements (P=.15 and P=.62, respectively). No patient required dialysis. There were three late deaths, none related to the renal procedure, providing 5- and 10-year survival of 85% and 68%, respectively. Conclusions: Ex vivo renal artery reconstruction for complex renal artery disease confers a benefit in blood pressure while preserving renal mass and function. This technique should be considered a competitive alternative to other open surgical techniques for the management of complex renal artery disease.