Renal artery stenosis surgery
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Renal artery stenosis Microchapters |
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Diagnosis |
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Renal artery stenosis surgery On the Web |
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American Roentgen Ray Society Images of Renal artery stenosis surgery |
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Risk calculators and risk factors for Renal artery stenosis surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Shivam Singla, M.D.[2]
Overview
While balloon angioplasty and surgery are associated with equal rates of improving renal function and hypertension in patients with renal artery stenosis (RAS), the higher rate of post-operative complications associated with the vascular surgical reconstruction makes angioplasty the preferred first-line treatment of RAS among patients requiring intervention. Vascular surgical reconstruction is reserved for a minority of cases. The need for surgical reoperation is 5-15%.
Surgery
Vascular surgical reconstruction is reserved for a minority of cases. Similar to all surgeries, vascular surgical reconstruction is associated with complications. The need for reoperation is documented in 5-15% of all Renal artery stenosis patients who require surgical intervention.[1][2][3][4][5]
Indications
Vascular surgical reconstruction is indicated in specific cases of atherosclerotic RAS[1][2][3][4][5]:
- Involvement of multiple small arteries
- Involvement of early primary branching of the main renal artery
- Renal artery reconstruction during pararenal aortic reconstruction in cases such as aortic aneurysms or aortoiliac occlusive disease
Risk Factors
The risk of complications associated with renal artery reconstruction increases in the following conditions:[1][2][3][4][5]:
- Concomitant aortic reconstruction
- Renal insufficiency
- Use of aortic grafts as bypass graft
Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations) : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[6]
| Class I | "1. Vascular surgical reconstruction is indicated for patients with fibromuscular dysplastic RAS with clinical indications for interventions (same as for PTA), especially those exhibiting complex disease that extends into the segmental arteries and those having macroaneurysms. (Level of Evidence: B)"
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References
- ↑ 1.0 1.1 1.2 Novick AC (1988). "Surgical correction of renovascular hypertension". Surg Clin North Am. 68 (5): 1007–25. PMID 3051450.
- ↑ 2.0 2.1 2.2 Cambria RP, Brewster DC, L'Italien GJ, Moncure A, Darling RC, Gertler JP; et al. (1994). "The durability of different reconstructive techniques for [[atherosclerotic]] [[renal artery disease]]". J Vasc Surg. 20 (1): 76–85, discussion 86-7. PMID 8028093. URL–wikilink conflict (help)
- ↑ 3.0 3.1 3.2 Novick AC, Ziegelbaum M, Vidt DG, Gifford RW, Pohl MA, Goormastic M (1987). "Trends in surgical revascularization for renal artery disease. Ten years' experience". JAMA. 257 (4): 498–501. PMID 3795433.
- ↑ 4.0 4.1 4.2 Libertino JA, Bosco PJ, Ying CY, Breslin DJ, Woods BO, Tsapatsaris NP; et al. (1992). "Renal revascularization to preserve and restore renal function". J Urol. 147 (6): 1485–7. PMID 1593670.
- ↑ 5.0 5.1 5.2 Clair DG, Belkin M, Whittemore AD, Mannick JA, Donaldson MC (1995). "Safety and efficacy of transaortic renal endarterectomy as an adjunct to aortic surgery". J Vasc Surg. 21 (6): 926–33, discussion 934. PMID 7776472.
- ↑ Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 61 (14): 1555–70. doi:10.1016/j.jacc.2013.01.004. PMC 4492473. PMID 23473760.