2007 Abstracts: Branch Renal Artery Repair With Cold Perfusion Protection

Background: This retrospective review describes the use and clinical outcome of cold perfusion protection during branch renal artery (RA) repair in 67 consecutive patients.
Methods: From July 1987 through July 2006, 855 patients had open operative RA repair to 1244 kidneys at our center. Sixty-seven patients (54 women, 13 men; mean age: 44 ± 17 years) had branch RA reconstruction using either ex vivo or in situ cold perfusion protection for 68 kidneys. Demographic data and surgical technique were examined. Blood pressure response was estimated. Patency of repair was determined by angiography and renal duplex sonography. Primary RA patency was estimated by life-table methods.
Results: Sixty-eight RA's were repaired using either ex vivo (45 kidneys) or in situ (23 kidneys) cold perfusion protection. Bilateral RA repair was performed in nineteen patients, including 11 repairs to solitary kidneys. RA disease included fibromuscular dysplasia (34 patients), atherosclerosis (4 patients), renal artery aneurysm (RAA; 44 patients), and arteritis (1 patient). Fifteen patients had both FMD and RAA. Hypertension was present in 95%(mean blood pressure: 184 ± 34/108 ± 19; mean medications: 1.93 ± 1.08 drugs). Renal artery repair included bypass using saphenous vein (59 RA's), hypogastric artery (3 RA's), composite vein/PTFE (2 RA's), PTFE (2RA's), or cephalic vein (1 RA). Of eight bilateral RA repairs to two kidneys, all were staged. One planned nephrectomy was performed for unreconstructible RA disease - no primary nephrectomies were required for intended reconstruction. Each RA reconstruction required branch dissection and reconstruction (mean branch repair: 2.7 branches). Mean cold ischemia time was 126 minutes. Each kidney was reconstructed in an orthotopic fashion. Intraoperative duplex (42 kidneys) and early postoperative angiography (12 patients) defined significant technical defects in 16.6%. There were four early failures of repair requiring three nephrectomies. Sixty-one of the sixty-seven patients had follow-up ( mean 37 months). Estimated primary patency of RA repair was 92.4%. Five patients had graft stenoses on surveillance duplex. Of those five one patient refused intervention, three patients underwent successful operative revision at the time of a contralateral renal artery bypass, and one patient had successful angioplasty and stenting of two graft stenoses. Among patients with preoperative hypertension, 15.6% were cured, 67.2% were improved, and 17.2% were considered failed.
Conclusion: Both ex vivo and in situ cold perfusion protection have utility in complex branch RA repair. These techniques resulted in no unplanned primary nephrectomies, with a primary patency of 92.4% at 37 months.