Renovascular operations in patients with chronic renal insufficiency

Do the benefits justify the risks?

John W. Hallett, Richard Fowl, Peter C. O'Brien, Philip E. Bernatz, Peter C. Pairolero, Kenneth J. Cherry, Larry H. Hollier

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

To define the benefits and risks of renal revascularization or nephrectomy in patients with both severe hypertension and chronic renal insufficiency, we analyzed 98 patients who underwent renovascular operations after serum creatinine levels exceeded 2 mg/dl. This subset of patients was selected from a retrospective review of 652 renal operations performed at the Mayo Clinic for renovascular disease between 1970 and 1981. Special attention was given to the type of operations, their effect on hypertension and renal function, specific factors that affected operative deaths, and late survival. Unilateral renal operations were performed in 48 patients with bilateral procedures in 50. Simultaneous aortic reconstruction was necessary in 55 patients (56%). Postoperative diastolic blood pressure was less than 90 mm Hg in 55% of patients and 90 to 100 mm Hg in an additional 33%. Seventy-six percent of patients required less antihypertension medication. Serum creatinine improved or stabilized in 69%. Ninety percent of patients avoided any early or late renal dialysis. The operative mortality rate was 7.1% and tended to be higher in patients with a serum creatinine greater than 3 mg/dl and in those with past myocardial infarction (p = 0.05). The late survival rate was 64% at 5 years. The main cause of operative and late death was myocardial infarction. In conclusion, most patients with renovascular hypertension and early chronic renal insufficiency can be benefited by surgical revascularization or nephrectomy. Future improvement in early and late survival may require a more aggressive approach to the identification and correction of significant coronary artery disease.

Original languageEnglish (US)
Pages (from-to)622-627
Number of pages6
JournalJournal of Vascular Surgery
Volume5
Issue number4
DOIs
StatePublished - 1987

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Chronic Renal Insufficiency
Creatinine
Nephrectomy
Kidney
Serum
Myocardial Infarction
Blood Pressure
Renovascular Hypertension
Renal Hypertension
Survival
Renal Dialysis
Coronary Artery Disease
Survival Rate
Hypertension
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Hallett, J. W., Fowl, R., O'Brien, P. C., Bernatz, P. E., Pairolero, P. C., Cherry, K. J., & Hollier, L. H. (1987). Renovascular operations in patients with chronic renal insufficiency: Do the benefits justify the risks? Journal of Vascular Surgery, 5(4), 622-627. https://doi.org/10.1016/0741-5214(87)90230-8

Renovascular operations in patients with chronic renal insufficiency : Do the benefits justify the risks? / Hallett, John W.; Fowl, Richard; O'Brien, Peter C.; Bernatz, Philip E.; Pairolero, Peter C.; Cherry, Kenneth J.; Hollier, Larry H.

In: Journal of Vascular Surgery, Vol. 5, No. 4, 1987, p. 622-627.

Research output: Contribution to journalArticle

Hallett, JW, Fowl, R, O'Brien, PC, Bernatz, PE, Pairolero, PC, Cherry, KJ & Hollier, LH 1987, 'Renovascular operations in patients with chronic renal insufficiency: Do the benefits justify the risks?', Journal of Vascular Surgery, vol. 5, no. 4, pp. 622-627. https://doi.org/10.1016/0741-5214(87)90230-8
Hallett, John W. ; Fowl, Richard ; O'Brien, Peter C. ; Bernatz, Philip E. ; Pairolero, Peter C. ; Cherry, Kenneth J. ; Hollier, Larry H. / Renovascular operations in patients with chronic renal insufficiency : Do the benefits justify the risks?. In: Journal of Vascular Surgery. 1987 ; Vol. 5, No. 4. pp. 622-627.
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