Aortorenal bypass with autologous saphenous vein in Takayasu arteritis-induced renal artery stenosis.

摘要

PURPOSE: To clarify the outcome of aortorenal bypass (ARB) in Takayasu arteritis-induced renal artery stenosis (TARAS). METHODS: A retrospective chart review was conducted on thirty-three consecutive patients (24 females; mean age, 25 years) with TARAS, who underwent ARB with autologous saphenous vein graft. The effects on blood pressure and renal function were analyzed. Primary, primary assisted, and secondary patency rates were counted. The effects of various factors on primary patency rate were analyzed. RESULTS: All patients showed severe hypertension (mean BP, 175 +/- 26/100 +/- 19 mm Hg; mean anti-hypertensive dosage, 2.1 +/- 0.6 DDD). Mean estimated glomerular filtration rate was 78 +/- 5.1 ml/min. One patient was dialysis-dependent, and three patients had congestive heart failure secondary to left-ventricular dysfunction. ARB was performed for the 39 renal arteries, including 27 unilateral and 6 bilateral bypasses. Postoperative morbidity was 15%. All patients survived. During follow-up (mean, 56 months), two graft occlusions and four graft restenosis occurred. All graft restenosis were eliminated successfully with percutaneous angioplasty, but one patient experienced restenosis again six months later. At 1, 3, and 5 years of follow-up, primary patency was 92%, 89%, and 79%, respectively; primary assisted patency was 95%, 95%, and 91%, respectively; and secondary patency was 95%, 95%, and 91%, respectively. ARB resulted in a decrease in mean BP to 139 +/- 15/85 +/- 13 mm Hg at one month (P < .05) and 136 +/- 19/80 +/- 8 mm Hg at last follow-up (P < .05). Mean anti-hypertensive dosage decreased to 1.4 +/- 0.8 DDD at one month (P < .05) and 0.6 +/- 0.8 DDD at last follow-up (P < .05). Mean estimated glomerular filtration rate increased to 82 +/- 4.7 ml/min (P > .05) at one month and 91 +/- 4.1 ml/min (P < .05) at last follow-up. The dialysis-dependent patient no longer required haemodialysis, and congestive heart failure resolved in all three patients. CONCLUSIONS: Our data suggest that ARB with autologous saphenous vein graft is safe, effective and durable in treating TARAS.