March 1985

The Significance of Hydronephrosis After Aortofemoral Reconstruction

Author Affiliations

From the Departments of Surgery (Drs Schubart, Fortner, Thiele, Bandyk, and Radke, and Ms Cummings) and Radiology (Dr Reed), University of Washington Hospital and the Seattle Veterans Administration Medical Center, Seattle. Dr Schubart is now with the Oregon Health Sciences University, Portland.

Arch Surg. 1985;120(3):377-381. doi:10.1001/archsurg.1985.01390270115020

• Hydronephrosis due to ureteral obstruction is a rarely reported complication of aortic bypass grafting. Patients who had undergone aortic reconstruction were screened using serial real-time ultrasound examination to detect ureteral obstruction. The clinical course and incidence of graft complications, renal impairment, amputation, and death were determined for hydronephrotic patients and compared with the incidence of similar complications in a control group. Hydronephrotic patients had an extremely high incidence of graft infection, anastomotic aneurysm, graft thrombosis, and amputation. Obstructed ureters were at high risk for intraoperative injury during removal of infected aortic grafts. A subgroup of hydronephrotic patients who developed multiple anastomotic aneurysms without graft infection was identified. Hydronephrosis was frequently silent, and detection required active investigation. After aortic reconstruction, routine screening with real-time ultrasound examination appears warranted to identify a high-risk subset of patients.

(Arch Surg 1985;120:377-381)