Revascularization of the solitary kidney: A challenging problem in a high risk population

J. M. Reilly, B. G. Rubin, R. W. Thompson, B. T. Allen, M. W. Flye, C. B. Anderson, G. A. Sicard, D. M. Shah, S. Knechtle

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background. Patients with significant atherosclerotic stenosis involving the artery to a solitary functioning kidney present a clinical challenge. Methods. From August 1987 through August 1995, 35 of these patients (average age, 68.4 ± 6.9 years) were treated. Comorbid conditions included previous myocardial infarction in 23% of the patients, congestive heart failure (CHF) in 34%, chronic obstructive pulmonary disease in 20%, and diabetes in 20%. The average creatinine level of the patients was 2.5 ± 1.5 mg/dl. Indications for revascularization were hypertension in 86%, hypertensive crisis with CHF in 17%, and renal insufficiency in 69%. Procedures performed included 19 extraanatomic bypasses, 8 concomitant with infrarenal aortic reconstruction and 2 concomitant with thoracoabdominal aortic aneurysm repair; 1 visceral segment endarterectomy; 1 renal artery endarterectomy with reimplantation; 1 superior mesenteric to renal artery bypass; 1 aortorenal bypass; and 2 percutaneous angioplasties with staged nephrectomies. Results. At discharged, 91% of patients had stable or improved renal function with an average creatinine level of 1.7 ± 0.8 mg/dl. Hypertension was cured or improved in 85%. Perioperative mortality was 6%, and major morbidity was 43%, including the need for permanent (9%) and temporary (9%) dialysis, respiratory insufficiency (18%), two early reoperations, six cardiac complications, one case of gastrointestinal bleeding, and one stroke. In the follow-up period (mean duration, 39.2 months), survival has been 73%, and no additional patients have required dialysis. Conclusions. Although significant perioperative morbidity exists in this high risk population, the long-term preservation of renal function and improvement in hypertension make solitary renal revascularization worthwhile.

Original languageEnglish
Pages (from-to)732-737
Number of pages6
Issue number4
StatePublished - 1996


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