Renal artery stenosis surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]
Overview
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 RAS patients who require surgical intervention.
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 RAS 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
It is important to note that vascular surgical reconstruction of the renal arteries may be complicated by associated risks. The risk of complications increases in the following conditions[1][2][3][4][5]:
- Concomitant aortic reconstruction
- Renal insufficiency
- Use of aortic grafts as bypass graft
2005 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) (DO NOT EDIT)[6]
Surgery (DO NOT EDIT)[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)" |
| "2. Vascular surgical reconstruction is indicated for patients with atherosclerotic RAS and clinical indications for intervention, especially those with multiple small renal arteries or early primary branching of the main renal artery. (Level of Evidence: B)" |
| "3. Vascular surgical reconstruction is indicated for patients with atherosclerotic RAS in combination with pararenal aortic reconstructions (in treatment of aortic aneurysms or severe aortoiliac occlusive disease). (Level of Evidence: C)" |
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.
- ↑ 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.
- ↑ 6.0 6.1 Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646. Retrieved 2012-10-09. Unknown parameter
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