Aortic and renal atherosclerotic disease

From 1972 to 1985, 39 patients underwent simultaneous aortic and renal revascularization. Thirty-six patients were hypertensive, whereas three patients were normotensive and the lesion of the renal artery was treated prophylactically. The operative mortality rate was 10 per cent. At late follow-up study, 65.6 per cent of the patients with hypertension were "cured" or "improved." Improvement of renal function was obtained in nine of 13 survivors with reduced renal function preoperatively. In addition, 133 patients who underwent aortic reconstruction without repairing the lesion of the renal artery because it was clinically "silent" were reviewed. Five patients experienced renal failure in the early postoperative period. At late follow-up study (a mean of 30 months), three of the 126 survivors died of renal failure and only 18 were hypertensive. Respectable results can be achieved after simultaneous aortic and renal revascularization. However, the increased operative mortality and morbidity warrants a conservative approach in patients considered at high risk or in whom stenosis of the renal artery causes few or no clinical problems.