Long-term results of treatment of the totally occluded renal artery in forty patients with renovascular hypertension.

A study of 40 patients with renovascular hypertension and a totally occluded renal artery was made to determine the optimal management of such lesions. There were 20 men and 20 women, ranging in age from 9 to 73 years (mean age, 51.4 years). Associated contralateral renal artery stenosis was present in 31 patients. Twenty-one patients underwent reconstruction of the occluded renal artery; 15 of the 21 experienced long-term success (up to 223 months) and six experienced failure. Sixteen patients underwent follow-up arteriography. The 14 patients who were treated by primary nephrectomy and reconstruction of a contralateral stenotic kidney had excellent results. In five patients, only a contralateral reconstruction was performed. Factors that were analyzed to determine the best predictors of success included age, sex, total renal function, contralateral reconstruction, associated vascular procedure, surgical technique, nephrogram or excretion of dye on intravenous pyelography, visualization of the distal renal artery on aortography, length of the kidney, and weight and pathology of the nephrectomy specimens. Only the size and weight of the kidney were consistent predictors of outcome. The preoperative demonstration of function in the kidney supplied by a totally occluded renal artery was unimportant. As a result of this study, we recommend reconstruction only for kidneys > 9.5 cm in length and nephrectomy or no treatment for smaller kidneys supplied by totally occluded renal arteries except when preservation of renal tissue is important. In such cases, revascularization of a small kidney can be accomplished but is associated with a significant risk of subsequent nephrectomy.