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May 1988

Renal Failure and Advanced Atherosclerotic Lesions: Salvage by Vascular Reconstruction

Author Affiliations

From the Department of Surgery, Maine Medical Center, Portland.

Arch Surg. 1988;123(5):610-613. doi:10.1001/archsurg.1988.01400290096016

• Occlusive renal artery lesions and progressive renal failure have a dismal prognosis if not treated. We analyzed our results to determine if the risks of renal vascularization were justified based on the final outcome in such patients. Inclusion criteria were a creatinine concentration of at least 160 μmol/L (1.8 mg/dL) and one of the following angiographic findings: (1) severe (≥75%) bilateral occlusions, (2) total occlusion with severe (≥75%) contralateral occlusion, or (3) solitary kidney with severe (≥75%) occlusion. Thirty patients met these criteria and underwent revascularization. Six required simultaneous aortic reconstruction. The average creatinine concentration on admission was 310 μmol/L (3.55 mg/dL); this had a statistically significant improvement to 210 μmol/L (2.41 mg/dL) at discharge. There was one perioperative death (3.3%). Initially, 22 patients had improved function (creatinine concentrations 20% lower), and seven patients had stable creatinine values. Eight patients ultimately required long-term dialysis. In the remaining 21 patients, with an average follow-up of 32 months, the average creatinine concentration was 220 μmol/L (2.51 mg/dL), still a significant improvement. Thus, we have demonstrated the relative safety and benefit of operating on these high-risk patients.

(Arch Surg 1988;123:610-613)

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