Aortorenal bypass with autologous saphenous vein in Takayasu arteritis-induced renal artery stenosis: an analysis of 33 cases.
- Author:
Rui FENG
1
;
Xiao-long WEI
;
Zhi-qing ZHAO
;
Jun-min BAO
;
Xiang FENG
;
Le-feng QU
;
Qing-sheng LU
;
Hua LU
;
Zai-ping JING
Author Information
- Publication Type:Journal Article
- MeSH: Adolescent; Adult; Aorta; surgery; Child; Female; Follow-Up Studies; Humans; Male; Middle Aged; Renal Artery; surgery; Renal Artery Obstruction; etiology; surgery; Retrospective Studies; Saphenous Vein; transplantation; Takayasu Arteritis; complications; Treatment Outcome; Young Adult
- From: Chinese Journal of Surgery 2011;49(11):1011-1016
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVETo clarify the outcome of surgical reconstruction for renal artery in Takayasu arteritis-induced renal artery stenosis (TARAS).
METHODSA retrospective chart review was conducted on 33 consecutive patients with TARAS, who underwent aortorenal bypass (ARB) with autologous saphenous vein graft. There were 9 male and 24 female patients, with a mean age of (25 ± 11) years. The effects on blood pressure and renal function were analyzed. Primary, primary assisted, and secondary patency rates were determined. The effects of various factors on primary patency rate were analyzed. All patients showed hypertension. The mean blood pressure was (175 ± 26)/(100 ± 19) mmHg (1 mmHg = 0.133 kPa). The mean antihypertensive dosage was (2.1 ± 0.6) defined daily dose (DDD). Seventeen patients showed intractable hypertension. Mean estimated glomerular filtration rate was (78 ± 5) ml/min. One patient was dialysis-dependent, and 3 patients were combined with congestive heart failure.
RESULTSARB was performed for the 39 renal arteries, including 27 unilateral and 6 bilateral bypasses. Postoperative morbidity was 15.2%. All patients survived. During follow-up of mean (56 ± 18) months, two graft occlusions and four graft restenoses occurred. All graft restenoses were eliminated successfully with percutaneous angioplasty, but one patient experienced restenosis again six months later. At 1, 3, and 5 years of follow-up, primary patency was 92%, 89%, and 79%, respectively, primary assisted patency was 95%, 95%, and 91%, respectively, and secondary patency was 95%, 95%, and 91%, respectively. ARB resulted in a decrease in mean blood pressure to 139/85 mmHg (one month post-ARB, P = 0.000) and 136/80 mmHg (last follow-up, P = 0.000), and a reduction in mean antihypertensive dosage to 1.4 DDD (one month post-ARB, P = 0.084) and 0.6 DDD (last follow-up, P = 0.000). Mean estimated glomerular filtration rate increased to 82 ml/min (P = 0.458) one month post-ARB, and 91 ml/min (P = 0.044) at last follow-up, respectively. The dialysis-dependent patient no longer required hemodialysis, and left ventricular dysfunction resolved in all of the three patients.
CONCLUSIONARB using the autologous saphenous vein graft is safe, effective and durable for treating TARAS.
