Supraceliac aortorenal bypass

Purpose: To determine the efficacy and durability of supraceliac aortorenal bypass grafting for symptomatic atherosclerotic renal artery disease. Methods: Retrospective review of a 10-year, single-institution experience. Results: Seventeen patients underwent 27 bypass procedures (seven unilateral, 10 bilateral) for atherosclerotic renovascular hypertension. The patients' mean age was 62.7 ± 8.8 years. Diffuse aortoiliac and visceral atherosclerosis was confirmed on arteriogram; most (88%) celiac axis branches and all infrarenal aortas and common iliac arteries were found unsuitable for use as a donor vessel. Twenty-six bypass procedures (96%) were performed with autologous vein grafts. Seventeen bypass procedures (63%) were performed during partial aortic occlusion. There were no operative deaths or early occlusions. Postoperative complications occurred in four patients (24%). The mean duration of follow-up was 28 ± 19 months (range, 2 to 69 months). By life table analysis, the 5-year primary patency and assisted primary patency rates were 95% and 100%, respectively. The mean systolic blood pressure decreased from 180 ± 38 mm Hg to 135 ± 20 mm Hg (p = 0.0003), and the mean diastolic blood pressure decreased from 96 ± 16 mm Hg to 77 ± 9 mm Hg (p = 0.0002). The number of antihypertensive medications decreased from 2.8 ± 1.2 to 1.4 ± 1.0 (p = 0.002). Significant improvement in serum creatinine level was seen among patients with preoperative renal insufficiency. Hypertension was cured in 29%, improved in 53%, and unchanged in 18%. During late follow- up, only four patients (24%) required subsequent aortic reconstruction. Conclusion: Supraceliac aortorenal bypass grafting is a safe and durable alternative for renal artery revascularization. This technique should be considered in patients who have diffuse infrarenal aortoiliac and visceral artery occlusive disease and require renal revascularization procedures.