From the BJU International Mini Reviews: Mechanisms of Renal Ischaemic Injury and Their Clinical Impact.

Surgical Indications

• Young patients - to avoid medical treatment of long duration.
• Failure of medical therapy
• Failure to tolerate medical regimens
• Deterioration of renal function in the presence of adequate blood pressure control
• Renal artery lesions not amenable to angioplasty (orificial stenosis, multiple branch lesions)

Preoperative Care and Evaluation

• Preoperative evaluation to identify patients with a high risk of a myocardial event or stroke
• Invasive monitoring of blood pressure and volume status should be used routinely

Surgical Procedures

• Aortorenal bypass
  • Reversed or nonreversed vein grafts from the infrarenal or supraceliac aorta
  • Prosthetic grafts
  • The supraceliac aorta
• Alternative renal artery reconstructive techniques may be used in specific clinical situations to avoid a diseased or otherwise unsuitable aorta as an inflow vessel
  • Hepatorenal bypass
  • Splenorenal bypass
  • Iliorenal bypass
  • Mesorenal bypass
• Aortorenal endarterectomy
  • May be performed through an aortic incision
  • Treatment of ostial lesions, directly removing the diseased intima and plaque.
• Heterotopic autotransplantation of the kidney to the iliac artery and vein relocating the kidney to the iliac fossa
• Ex vivo arterial repair in which the kidney is removed from the patient allowing precise reconstruction of the renal vessels under ex vivo conditions of exposure, illumination, and magnification.

Percutaneous Transluminal Angioplasty (PTA)

• Patients with both arteriosclerotic and fibrodysplastic lesions can be treated by PTA
• May be performed routinely if angiography demonstrates a significant renovascular lesion amenable to angioplasty based on the observation that a significant number of patients with RVH do not have demonstrable involvement of the renin-angiotensin system and that no tests or combination of tests yield a reliable diagnosis of RVH

References

Calligaro P, Modern Management of Renovascular Hypertension and Renal Salvage, Williams & Wilkins, 1996.

Dean RH, Krueger TC, Whiteneck JM, et al: Operative management of renovascular hypertension: Results after a follow-up of fifteen to twenty-three years. J Vasc Surg 1:234-422, 1984.

Galanski M, Prokop M, Chavan A, et al: Renal artery stenosis: Sprial CT angiography. Radiology 189:185-192, 1993.

Martin LG, Price RB, Casarella WJ, et al: Percutaneous angioplasty in the clinical management of renovascular hypertension: Initial and long term results. Radiology 155:629, 1985.

Meier GH, Sumpio B, Black HR, Gusberg RJ; Captopril renal scintography. An advance in the detection and treatment of renovascular hypertension. J Vasc Surg 11:770-777, 1990.

Prince MR, Narasimham DL, Stanley JC, et al: Breath-hold gadolinium-enhanced MR angiography of the abdominal aorta and its major branches. Radiology 197:785, 1995.

Raynaud AC, Beyssen BM, Turmel-Rodrigues LE, et al. Renal artery stent placement: Immediate and midterm technical and clinical results. JVIR 5:849, 1994.

Strandnesss DE. Duplex scanning in diagnosis of renovascular hypertension. Surg Clin North Am 70:109-117, 1990.

Please log-in or register in order to submit comments.

Powered by AkoComment!