EARLY OUTCOMES OF SURGICAL MANAGEMENT OF CRONIC RENAL ISCHEMIA

THE AIM of the investigation was to estimate the early outcomes of surgical treatment of patients with chronic renal ischemia. PATIENTSAND METHODS. Surgical treatment of chronic renal ischemia was carried on in 34 out of 40 patients with occlusive-stenotic Iesionsofthe renal arteries (19 men and 15 women aged from 18 to 78, average 53± 14 years). The causes of the lesions of the renal arteries (RA) were as follows: atherosclerosis (30), fibromuscular dysplasia (1), periprosthetic fibrosis (1), thromboangiitis (1) and diaphragmatic compression (1). Bilateral lesion of RA were foundin 14 patients, 13 out of them had atherosclerosis. Arterial hypertension (AH) was found in 34 patients, azotemia (creatinin from 0.013 to 0.4 mmol/l, average 0.19±0.07) in 15 patients with atherosclerosis. Revascularizationwas performed in 34 kidneys in 29 patients (bilaterally in 5) by means of 24 shuntingsof RA(4extraanatomical), 1 endarterectomy, 1 prosthesis, 1 decompression and 7 endovascular angioplasties. Nephrectomy only was performed in 5 cases. Combined operations were performed in 8 patients (24%). RESULTS. AH was arrested in 11 (39%) patients, its course was better in 15 (54%), remained unchanged in 2 (7%). Functions of the kidneys were improved in 6 (67%), stabilized in 2 (22%) patients and deteriorated in 1 (11%). Lethal outcomes (n=6; 17.6%) took place only in patients with azotemia after combined operations. CONCLUSION. Revascularization of the kidneys was effective in the correction of the renal function and AH, but azotemia worsened the results of surgical treatment in the earliest postoperative period.

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