SUMMARY SURGICAL TREATMENT OF OCCLUDED RENAL ARTERY AND THE LONG TERM RESULTS

Purpose: Nephrectomy or revascularization are currently the preferred optlons In the management of the chronically occiuded renal artery in palients with renovascular hypertension or renal Insufficency. Our experience with these two options for chronic renal artery occiusion, including early and late functional outcome, was reviewed.

Mothods: Between 1991 and 1998, chronic occlusion of the main renal artery was dacumented in 30 patients. Pati-enis were categorized with respect to surglcal intervention; Group 1 - nephrectomy; Group 11- revascularization of the occluded renal artery.

Results: The median ege at the time of operative intervention was 63 years, with 53% females and 47% males. Hypertenslon was poorly controlled (3 medicalions) in 19 patients, and preoperative serum creatinine was greater !han 1.8 mg/cll in 24 patiens (mean: 2,6±14 mgid1). There were total of 16 patients in Group I and 14 palients in Gro-up Il. Estimated glomerular filtration rate (>7 days after operation) was either unchanged or improved in 15 of 18 pa-!lents in Group I and in 13 of 14 Group Il patients, one of whom became dialysis dependent. Follow-up was availab-le on 25 of 30(83%) of patients (mean: 45 months; range: 9-108 months). There were no perioperative deaths. Exc-luding one early failure,10 of 13 patients in Group( and 7 of 11 patients in Group Il had not developed endstage renal disease at last follow-up, °veren, hypertension was cured or improved in 16 of 21 patients.

Conclusions: Revascuiarization, as the preferred method of treatment of the occluded renal artery, offers the pros-pect of renal salvage. Nonetheless in the majority of properly selected patients, adequate renal function may be sus-tained and satisfactory blood pressure control achieved atter nephreclomy with contralateral revascularization