Extracorporeal replacement of the renal artery: techniques, indications and long-term results.

Extracorporeal repair of the renal artery was done in 24 patients for complex lesions extending to branches of the renal artery (9 dysplasias, 5 atheromas and 10 aneurysms). The renal artery and its branches were replaced by a hypogastric branched autograft in 20 patients and a saphenous vein graft in 4. Indications for an extracorporeal operation were hypertension, preservation of renal function against progressive deterioration and extension of the lesion to more than 2 branches of the renal artery. Of 76 peripheral anastomoses 68 were patent postoperatively. Two secondary nephrectomies were performed. Mean followup was 54 months. Hypertension was cured in 19 patients and improved in 2, while 2 failed treatment and 1 died. An extracorporeal operation may represent the best alternative for treatment of renal arterial lesions involving more than 2 branches.