Simultaneous aorto-renal reconstruction and consideration to the value of combined approach. A 2-16 years follow-up study, with review of the literature.

Thirty five patients who underwent simultaneous aortic and renal artery reconstruction are reviewed, to determine the value of the combined approach. The risk factors determining operative morbidity and mortality are discussed, on the basis of a long term follow-up of more than sixteen years. All patients had a significant renal artery stenosis, in addition to either severe aorto-iliac occlusive disease or an abdominal aortic aneurysm. Twenty seven patients were hypertensive, and eight patients normotensive. Combined aorto-renal reconstruction was carried out prophylactically in eight instances. There were two operative deaths (5.7%). Factors found to be associated with an increased operative risk were advanced age (over 65 years), heart disease with ECG changes, severe hypertension and diabetes. Renal insufficiency with azothaemia and high levels of creatinine, represented a major risk factor. Post operatively, six individuals (24%) were classified as "cured" and thirteen (523) were "improved". Patients with bilateral renal artery stenosis, mild azothemia and moderately elevated creatinine, were found to improve significantly their renal function post operatively. No patient required hemodialysis. Simultaneous aorto-renal reconstruction may be performed with a low mortality and gratifying improvement in hypertensive patients, without evidence of adverse features.