Tarazi R Y, Hertzer N R, Beven E G, O'Hara P J, Anton G E, Krajewski L P
J Vasc Surg. 1987 May;5(5):707-14. doi: 10.1067/mva.1987.avs0050707.
From 1973 through 1984, graft replacement of infrarenal aortic aneurysms (N = 56) or occlusive disease (N = 33) was performed in conjunction with simultaneous renal revascularization in 89 patients. Isolated renal artery stenosis was corrected by unilateral reconstruction in 56 patients (63%), but the remaining 33 (37%) had diffuse involvement that required either bilateral renal artery grafts or unilateral revascularization of solitary kidneys. The incidence of hypertension (greater than 180/90 mm Hg) refractory to preoperative medical therapy (88%), severe coronary disease documented by angiography (40%), and postoperative azotemia (33%) or oliguric renal failure (15%) was significantly higher among patients with bilateral renal artery disease (p less than 0.05). In addition, this group had twice the early mortality rate (15%) of patients having unilateral renal artery lesions (7.1%). During a mean follow-up interval of 37 months, medical control of hypertension was enhanced in 46 of the 80 operative survivors (58%), and renal function improved or remained stable in 63 survivors (79%). Five-year actuarial survival presently is 65% for the entire series, with a cumulative mortality rate of 38% among patients who underwent aneurysm resection (mean age 64 years) in comparison to 15% (p = 0.03) for those patients with aortoiliac occlusive disease (mean age 60 years).
1973年至1984年期间，89例患者在进行肾血管重建的同时，接受了肾下腹主动脉瘤移植置换术（n = 56）或闭塞性疾病手术（n = 33）。56例患者（63%）通过单侧重建纠正了孤立性肾动脉狭窄，但其余33例（37%）有弥漫性病变，需要进行双侧肾动脉移植或对孤立肾进行单侧血管重建。双侧肾动脉疾病患者中，术前药物治疗难以控制的高血压（大于180/90 mmHg）发生率（88%）、血管造影证实的严重冠状动脉疾病发生率（40%）以及术后氮质血症发生率（33%）或少尿性肾衰竭发生率（15%）显著更高（p < 0.05）。此外，该组患者的早期死亡率（15%）是单侧肾动脉病变患者（7.1%）的两倍。在平均37个月的随访期内，80例手术幸存者中有46例（58%）高血压得到更好的药物控制，63例幸存者（79%）肾功能改善或保持稳定。目前整个系列的5年精算生存率为65%，接受动脉瘤切除术的患者（平均年龄64岁）累积死亡率为38%，而主动脉髂动脉闭塞性疾病患者（平均年龄60岁）的累积死亡率为15%（p = 0.03）。
