Management of renovascular problems during aortic operations.

Sixty patients who had primary aortic disease (aortic stenosis or aneurysm) and required simultaneous aortic and renal artery operations were divided according to the indications for renal artery repair as follows: group 1, renovascular hypertension (ten patients); group 2, kidney salvage (11 patients); group 3, improvement of renal function (three patients); and group 4, renal artery involvement in the diseased aorta (36 patients). Renal artery reimplantation and aortorenal grafting were usually employed. Two kidneys in the renal salvage group failed, and two main and three accessory arteries were found to be occluded on late follow-up. Three patients died after emergency surgery for aneurysm rupture (two patients) and infected false aneurysm (one patient). The mortality rate for combined operations is higher (5%) than for aortic or renal surgery alone, but simultaneous repair may be needed for technical reasons, or to treat renovascular disease.