Vaskulárna medicína 2/2013
Our experience with surgical renal revascularization
Introduction. Open surgical revascularization of kidney because of the renovascular hypertension and ischaemic nephropathy (RVH/ IN) has been still very important in spite of the dominant role of the endovascular treatment in present times. Methods. We have evaluated retrospectively open revascularization surgery in our patients during 14 years time period (1999-2012). During this time period we have realized 50 open surgical reconstructions in 50 patients. In 25 cases the operations have been performed because of RVH/IN. The second half of the patients population have been operated on the renal arteries in the frame of any complex surgery, particularly open surgery of aortic aneurysms. We have recorded the type of surgical reconstruction, its efectiveness from the point of view of the blood pressure and secretory renal functions, complications and mortality, as well. Discussion. In this paper we have briefly described several types of renal arteries reconstructions, both anatomical and extraanatomical and their position in vascular surgical practise. We have postulated our standpoint to indications both endovascular and open surgical renal revascularization because of RVH/IN. In spite of the fact that no big randomized study has been published up to the present days accomplishing the benefit of the endovascular revascularization for the patients comparing with medical therapy alone or with open surgical reconstructions, many vascular centres consider PTRA with stent implantation as the method of choice in the management of RVH/IN. We have compared the numbers of endovasculary and surgically treated cases in our institution during the period mentioned above, as well. Conclusion. Surgical revascularization do not belong in between most frequent reconstructions in vascular surgery, however, their importancy is still substantial from the point of view of their potencial of successful treatment of the RVH/IN. We can register contemporary renaissance of open renal revascularization in many big centres in the world. It is necessary to enhance the proportion of open renal revascularizations also in our hands. It is apparent that in the next future there will rise the number of hybrid reconstructions and so called „debranching“ operations in big reconstructive aortic surgery. Renal arteries revascularizations presume multidisciplinary consensus and cooperation.
Keywords: renovascular hypertension, ischaemic nephropathy, open surgical revascularization.
