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  • Title: [Reoperations on the renal artery].
    Author: Lacombe M.
    Journal: Chirurgie; ; 119(9):545-50. PubMed ID: 7729203.
    Abstract:
    Twenty six reoperations on the renal artery were performed upon 19 patients. This represents a 3.6% rate of repeat surgery in the author's series of renal artery repairs. The lesions requiring surgery were 22 repeat stenoses and 4 aneurysms of saphenous vein grafts. The 26 reoperations ended with nephrectomy in 8 cases and repeat repair in 18 cases. The nephrectomies were performed because of major difficulties for a repeat repair. The repairs were performed by conventional surgery in 9 cases and ex situ surgery in 9 cases. One postoperative death occurred (5.2%). Early thrombosis of segmental branches occurred in one patient requiring secondary nephrectomy. Late thrombosis of the repair occurred in one case in spite of normal patency of the repair on early postoperative angiography, and did not require any further surgery. Three repeat stenoses occurred (15.7%): one was not reoperated, the two others underwent one nephrectomy and one repair. On the whole, 12 long term successes out of 18 repeat repairs were obtained (66.6%). The results of successful repairs on renal function and blood pressure control are similar to those of primary repairs. Two reasons explain late alterations of initially satisfactory repairs: in only 3 cases (15.7%) worsening of atherosclerosis was responsible for repeat stenoses; in the majority of cases (16 out of 19, i.e. 84.3%), late alterations of the repair or of the arterial substitute occurred. The former lesions are unavoidable, the occurrence of the latter may be prevented by adequate surgical tactics or technique of the primary operation.
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