Fate of Bypass Grafts for Renal Artery Reconstruction: Angiographic Findings

ABSTRACT

Renal atery reconstuction (RAR) for renal artery stenosis has been preferred selective method to correct hypertension and to preserve renal function. But evaluation of renal artery reconstruction with use of angiography has demonstrated not only postoperative graft occlusion due to technical problem but also long term graft failure in 7~20%. This is thought to be due to intimal hyperplasia of anastomotic, midgraft or primary disease progression or extensive fibrosis on the surface of the graft compresssing the lumen. From August 1983 to Februrary 1997, we reviewed 7 patients with 12 grafts who were undertaken aortorenal bypass and performed angiographic study following at least 2 years after operation among 32 patients during these periods. The follow-up period ranged from 24 months to 124 months (average 76 month)with studies of CT angiography in 6, conventional angiography in 1. There were 4 male and 3 female patients, and their age ranged from 17 to 50 (median age 31). The causes of the renal artery stenosis in renovascular hypertension were athersclerosis in 2, Takayasu's arteritis in 4, fibromuscular dysplasia in 1. Postoperative blood pressure response showed cure in 2, improvement in 5 according to previously published criteria. The long term angiographic finding showed occlusion in 2, stenosis in 1, dilatation in 1 among vein grafts and stenosis in 1, occlusion in 1 among PTFE grafts. There was no change of renal function during perioperative period. Despite short term good results of renovascular reconstructions, many graft abnormalities were observed. We conclude that regular morphologic follow-up study is required as a postoperative surveillance after renovascular reconstruction.