Long-Term Survival After Surgical Revascularization for Atherosclerotic Renal Artery Disease

No AccessJournal of UrologyClinical Urology: Original Article1 Jul 1997Long-Term Survival After Surgical Revascularization for Atherosclerotic Renal Artery Disease Frank Steinbach, Andrew C. Novick, Stephen Campbell, and Dawn Dykstra Frank SteinbachFrank Steinbach , Andrew C. NovickAndrew C. Novick , Stephen CampbellStephen Campbell , and Dawn DykstraDawn Dykstra View All Author Informationhttps://doi.org/10.1097/00005392-199707000-00011AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We analyzed the long-term clinical outcome and survival after surgical revascularization for atherosclerotic renal artery stenosis. Materials and Methods: The study group comprised 222 patients who underwent surgical revascularization for atherosclerotic renal artery stenosis between 1974 and 1987. The indications for performing surgical revascularization were treatment of hypertension in 60 patients, preservation of renal function in 12, and control of hypertension and preservation of renal function in 148. Postoperative blood pressure, renal function and survival data were analyzed during a mean followup of 7.4 years. Results: There were 5 operative deaths (2.2%) and postoperative thrombosis or stenosis of the repaired renal artery occurred in 16 patients (7.3%). Long-term cure or improvement of renovascular hypertension was achieved in 72.4% of patients. Preoperative renal function correlated significantly with a favorable blood pressure response to surgical revascularization (p = 0.013). Long-term improvement or stabilization of renal function was achieved in 71.3% of patients. Preoperative renal function (p = 0.034) and bilateral atherosclerotic renal artery stenosis (p = 0.04) correlated significantly with a favorable renal function result after surgical revascularization. Actuarial 5 and 10-year survivals for the entire series from the time of surgical revascularization were 81 and 53%, respectively. The expected 5 and 10-year survivals for a comparable healthy population are 89 and 77%, respectively. Using a multivariate analysis, factors correlating with diminished long-term survival were age older than 60 years (p = 0.002), coronary artery disease (p = 0.031), and previous vascular operations (p = 0.001). Conclusions: These data support the long-term therapeutic efficacy of surgical revascularization in patients with atherosclerotic renal artery stenosis. The merits of newer forms of therapy, such as percutaneous transluminal angioplasty and endovascular stenting, must ultimately be weighed against these results. References 1 : Atherosclerotic renovascular disease.. J. Urol.1981; 126: 567. Abstract, Google Scholar 2 : Diminished operative morbidity and mortality in renal revascularization.. J.A.M.A.1981; 246: 749. Google Scholar 3 : Trends in surgical revascularization for renal artery disease. Ten years' experience.. J.A.M.A.1987; 257: 498. Google Scholar 4 U.S. National Center for Health Statistics: Statistical Abstracts of the United States, 1994. Google Scholar 5 : Changing concepts in surgical management of renovascular hypertension.. Arch. Intern. Med.1988; 148: 357. Google Scholar 6 : Patient selection for intervention to preserve renal function in ischemic renal disease. In: Renal Vascular Disease. Edited by . Philadelphia: W. B. Saunders Co.1996: 323. Google Scholar 7 : Operative morbidity and mortality in renal and renovascular disease.. J.A.M.A.1975; 231: 1148. Google Scholar 8 : Contemporary surgical management of renovascular disease.. J. Vasc. Surg.1992; 16: 319. Google Scholar 9 : Renal revascularization to preserve and restore renal function.. J. Urol.1992; 147: 1485. Abstract, Google Scholar 10 : Changing patterns in surgery for chronic renal artery occlusive disease.. J. Vasc. Surg.1992; 15: 1018. Google Scholar 11 : The contemporary role of extra-anatomical surgical renal revascularization in patients with atherosclerotic renal artery disease.. J. Urol.1995; 153: 1798. Abstract, Google Scholar 12 : Controlling atherosclerotic renovascular hypertension.. Geriatrics1974; 28: 124. Google Scholar 13 : Clinical course of atherosclerotic renovascular disease.. Amer. J. Cardiol.1968; 21: 60. Google Scholar 14 : Renal revascularization for atherosclerotic renovascular hypertension: prognostic implications of focal renal arterial vs.. overt generalized arteriosclerosis. Surgery1973; 73: 859. Google Scholar 15 : Renal and renovascular hypertension.. A reasoned approach to diagnosis and management. Arch. Intern. Med.1974; 133: 988. Google Scholar 16 : Late results of reconstructive surgery for renovascular disease.. Ann. Surg.1980; 191: 528. Google Scholar 17 : Complications of abdominal aortic reconstruction: an analysis of perioperative risk factors in 557 patients.. Ann. Surg.1983; 197: 49. Google Scholar 18 : Renovascular reconstruction: factors affecting long-term prognosis in 919 patients followed up to 31 years.. Amer. J. Cardiol.1989; 63: 1085. Google Scholar 19 : The durability of different reconstructive techniques for atherosclerotic renal artery disease.. J. Vasc. Surg.1994; 20: 76. Google Scholar From the Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byMAREKOVIĆ Z, MOKOS I, KRHEN I, GORETA N and RONČEVIČ T (2018) Long-Term Outcome After Surgical Kidney Revascularization for Fibromuscular Dysplasia and Atherosclerotic Renal Artery StenosisJournal of Urology, VOL. 171, NO. 3, (1043-1045), Online publication date: 1-Mar-2004.Novick A (2018) Editorial commentJournal of Urology, VOL. 167, NO. 2 Part 2, (828-828), Online publication date: 1-Feb-2002.Goldfarb D (2018) RENAL TRANSPLANTATION AND RENOVASCULAR HYPERTENSIONJournal of Urology, VOL. 166, NO. 3, (1197-1201), Online publication date: 1-Sep-2001.Novick A (2018) KIDNEY TRANSPLANTATION AND RENOVASCULAR HYPERTENSIONJournal of Urology, VOL. 164, NO. 3 Part 1, (897-900), Online publication date: 1-Sep-2000.Rundback J, Gray R, Rozenblit G, Poplausky M, Babu S, Shah P, Butt K, Tomasula J, Garrick R, Goodman A, Dolmatch B and Horton K (2018) Renal Artery Stent Placement for the Management of Ischemic NephropathyJournal of Urology, VOL. 161, NO. 6, (2031-2032), Online publication date: 1-Jun-1999.KRISHNAMURTHI V, NOVICK A and MYLES J (2018) ATHEROEMBOLIC RENAL DISEASE: EFFECT ON MORBIDITY AND SURVIVAL AFTER REVASCULARIZATION FOR ATHEROSCLEROTIC RENAL ARTERY STENOSISJournal of Urology, VOL. 161, NO. 4, (1093-1096), Online publication date: 1-Apr-1999.Baboolal K, Evans C and Moore R (2018) Incidence of End-Stage Renal Disease in Medically Treated Patients With Severe Bilateral Atherosclerotic Renovascular DiseaseJournal of Urology, VOL. 161, NO. 3, (1031-1031), Online publication date: 1-Mar-1999. Volume 158Issue 1July 1997Page: 38-41 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.Metrics Author Information Frank Steinbach More articles by this author Andrew C. Novick More articles by this author Stephen Campbell More articles by this author Dawn Dykstra More articles by this author Expand All Advertisement PDF downloadLoading ...