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Surgical revascularization of renal artery after complicated or failed percutaneous transluminal renal angioplasty  Michel Lacombe, MD, Jean-Baptiste.

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Presentation on theme: "Surgical revascularization of renal artery after complicated or failed percutaneous transluminal renal angioplasty  Michel Lacombe, MD, Jean-Baptiste."— Presentation transcript:

1 Surgical revascularization of renal artery after complicated or failed percutaneous transluminal renal angioplasty  Michel Lacombe, MD, Jean-Baptiste Ricco, MD, PhD  Journal of Vascular Surgery  Volume 44, Issue 3, Pages (September 2006) DOI: /j.jvs Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

2 Fig 1 Patient age distribution according to the etiology of renal artery disease. For the entire series, mean age was 34.4 years, and median age was 28 years (25th percentile, 13.5 years; 75th percentile, 59.5 years). Bimodal age distribution was correlated with underlying disease etiology. Young patients presented with renal fibrodysplasia or Takayasu’s disease (mean age, 18 ± 11 years), whereas older patients presented with atheroma disease (mean age, 61 ± 12 years). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

3 Fig 2 Study flowchart shows the outcome of 52 percutaneous transluminal renal angioplasties (PTRA) procedures in 45 patients. Major complications of PTRA occurred in 19 arteries (15 patients) and immediate or late failure occurred in 33 PTRA (30 patients). Forty-eight renal artery reconstruction procedures were performed, including 10 involving extracorporeal repair. Primary nephrectomy was performed in three cases. One patient had an atrophic kidney that prevented operative treatment. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

4 Fig 3 Angiography shows covered perforation of a renal artery during angioplasty. Large arrow indicates a periarterial hematoma. Small arrow indicates the angioplasty catheter. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

5 Fig 4 Operative view shows postangioplasty dissection of the renal artery associated with arterial thrombosis. The patient underwent emergent treatment. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

6 Fig 5 A, Angiography shows dissection (arrow) after angioplasty of a recurrent stenosis of the left renal artery after splenorenal anastomosis in a patient with only one kidney. B, Angiography after emergent extracorporeal repair with autotransplantation of the kidney into the left iliac fossa and renal artery anastomosis to the common iliac artery. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

7 Fig 6 Significant aggravation of a renal artery stenosis after angioplasty in a patient with arterial fibrodysplasia. A, Initial status: right renal artery fibrodysplasia with proximal stenosis (arrow). B, Final status after two angioplasties. The stenosis (arrows) has extended and now involves the full length of the previously healthy superior renal artery branch. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

8 Fig 7 Evolution of a pseudo aneurysm occurring after a right renal artery angioplasty. A, Immediate result after angioplasty in September B, Same artery in January 2001. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

9 Fig 8 Primary patency (Kaplan-Meier method) observed after 48 renal artery revascularization procedures with the number of patients exposed to risk for each interval and calculation of 95% confidence interval. At 5 years, primary patency was 94.1% ± 5.8% for the 18 revascularizations in patients with atheromatous lesions (full lines), and 93.3% ± 6.7% for the 30 revascularizations in patients with nonatheromatous lesions (dotted lines). Primary patency was 93.5% ± 6.5% at 5 years for the entire series. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

10 Fig 9 Interval between the last percutaneous transluminal renal artery angioplasty (PTRA) and open surgical treatment. The mean interval (vertical line) was 263 days (25th percentile, 11 days; 75th percentile, 285 days). Thirteen procedures (25.5%), including seven emergent procedures, were performed ≤first 30 days after PTRA. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

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