Surgical revascularization of renal artery after complicated or failed percutaneous transluminal renal angioplasty

PURPOSE: The purpose of this study was to evaluate the feasibility and effectiveness of surgical reconstruction of the renal artery after complicated or failed percutaneous transluminal renal angioplasty (PTRA). METHODS: This was a retrospective study of 45 consecutive patients who were referred to our centers for surgical renal artery reconstruction after 52 complicated or failed PTRA procedures performed between 1980 and 2003. There were 27 women and 18 men, with a median patient age of 28 years (25th percentile, 13.5 years; 75th percentile, 59.5 years). The mean number of PTRA per artery per patient was 1.4 +/- 0.6. Renal artery stenosis was due to arterial fibrodysplasia in 25 patients, atherosclerosis in 17, and inflammatory arteritis in three. RESULTS: Forty-eight renal artery revascularizations were performed (3 bilateral). The procedure consisted of in situ surgery in 38 patients (79%) and extracorporeal repair in 10 (21%). Primary nephrectomy was required in three patients. One patient did not undergo surgical repair after failed PTRA because of kidney atrophy. Major technical problems were encountered during surgical revascularization in 14 (74%) of the 19 patients treated after complicated PTRA and in four (12%) of the 33 patients treated after failed PTRA. Multiple organ failure led to one death on postoperative day 90 in a patient with atherosclerosis and severe kidney insufficiency. Postoperative thrombosis of the repaired renal artery led to kidney loss in three patients, but only one patient required secondary nephrectomy. Primary patency for the overall series of renal revascularizations was 93.5% +/- 6.5% at 5 years. CONCLUSION: Surgical reconstruction after complicated or failed PTRA is feasible and effective and allows kidney salvage in most patients. Technical problems during surgical revascularization may require extracorporeal repair in some patients. The results of this study underline the need for careful patient selection and skillful PTRA technique.