Harris J P, Walker P J, White G H, May J
Department of Vascular Surgery, Royal Prince Alfred Hospital, University of Sydney, New South Wales, Australia.
Ann Vasc Surg. 1991 Mar;5(2):138-42. doi: 10.1007/BF02016746.
Between 1968 and 1989, 160 patients underwent aortorenal bypass for renovascular hypertension. During the same interval, 13 patients had ex-vivo bench repair of complex renal arterial pathology. There were eight men and five women, with a mean age of 36 years. Twelve of the 13 patients had fibromuscular disease; one had atherosclerosis. Twelve patients had renovascular hypertension with complex stenotic disease beyond the main renal artery. Seven of these also had an associated renal aneurysm as did the sole normotensive patient. Saphenous vein patch or bypass were used to correct stenotic segments in four patients, while the remaining nine patients had excision of stenotic or aneurysmal segments with primary arterial anastomosis. There were no deaths in the series. One kidney was lost because of arterial thrombosis. One patient required reoperation to control postoperative bleeding. Nine of the 12 patients with renovascular hypertension were normotensive off medication, and three were improved, with reduced medication controlling their blood pressure. Ureteric obstruction occurred in two patients; this settled spontaneously in one patient and was corrected by reoperation in the other. From this experience, we conclude that bench repair is a safe and effective way to maximize salvage of kidneys affected by complex arterial pathology.
1968年至1989年间，160例患者因肾血管性高血压接受了主动脉 - 肾动脉搭桥手术。在同一时期，13例患者对复杂的肾动脉病变进行了体外平台修复。其中男性8例，女性5例，平均年龄36岁。13例患者中有12例患有纤维肌性疾病；1例患有动脉粥样硬化。12例患者患有肾血管性高血压，主要肾动脉以外存在复杂的狭窄性疾病。其中7例以及唯一血压正常的患者还伴有肾动脉瘤。4例患者使用大隐静脉补片或搭桥来纠正狭窄段，其余9例患者切除狭窄或动脉瘤段并进行一期动脉吻合。该系列中无死亡病例。1例肾脏因动脉血栓形成而丢失。1例患者需要再次手术以控制术后出血。12例肾血管性高血压患者中有9例在停用药物后血压正常，3例病情改善，通过减少药物用量控制血压。2例患者出现输尿管梗阻；其中1例自行缓解，另1例通过再次手术纠正。基于此经验，我们得出结论，平台修复是最大限度挽救受复杂动脉病变影响的肾脏的一种安全有效的方法。
