Chirurgie; memoires de l'Academie de chirurgie · 1998
[Extracorporeal surgery of the renal artery].
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Lacombe M
Аннотация
PURPOSE: The aim of the study was to assess the short- and long-term results of ex situ renal artery repair in a homogeneous series of patients operated on for complex lesions of this artery.
MATERIAL AND METHODS: Seventy-seven patients (38 males and 39 females) underwent 80 extracorporeal repairs of the renal artery. The operated lesions were: aneurysms of the artery and/or of its branches with or without associated dysplasia (30 cases), extensive fibrodysplasia extending to distal branches (31 cases), spontaneous dissection of the artery with extension to the branches (nine cases), reoperation on the renal artery (six cases), miscellaneous (four cases). In all cases, the kidney was exteriorized after transsection of its vessels and cooled by perfusion of cold Collin's solution. After repair, it was reimplanted in the lumbar (36 cases) or iliac fossa (44 cases). An arterial substitute was used in 59 cases.
RESULT: No mortality was observed in this series. Five postoperative thromboses occurred leading to kidney loss (6.25%). Segmental thrombosis leading to partial atrophy of the kidney occurred in three cases (3.75%). During the long-term follow-up, one repeat stenosis and four fusiform dilations of venous autografts were observed. All other repairs were successful (89.3%). Results on blood pressure control were favourable in 88.7% of the cases.
CONCLUSIONS: Ex situ repair must be reserved to lesions involving several branches of the artery whose repair requires prolonged circulatory arrest and lesions profoundly situated in the renal sinus whose repair is difficult by conventional in situ surgery.
MATERIAL AND METHODS: Seventy-seven patients (38 males and 39 females) underwent 80 extracorporeal repairs of the renal artery. The operated lesions were: aneurysms of the artery and/or of its branches with or without associated dysplasia (30 cases), extensive fibrodysplasia extending to distal branches (31 cases), spontaneous dissection of the artery with extension to the branches (nine cases), reoperation on the renal artery (six cases), miscellaneous (four cases). In all cases, the kidney was exteriorized after transsection of its vessels and cooled by perfusion of cold Collin's solution. After repair, it was reimplanted in the lumbar (36 cases) or iliac fossa (44 cases). An arterial substitute was used in 59 cases.
RESULT: No mortality was observed in this series. Five postoperative thromboses occurred leading to kidney loss (6.25%). Segmental thrombosis leading to partial atrophy of the kidney occurred in three cases (3.75%). During the long-term follow-up, one repeat stenosis and four fusiform dilations of venous autografts were observed. All other repairs were successful (89.3%). Results on blood pressure control were favourable in 88.7% of the cases.
CONCLUSIONS: Ex situ repair must be reserved to lesions involving several branches of the artery whose repair requires prolonged circulatory arrest and lesions profoundly situated in the renal sinus whose repair is difficult by conventional in situ surgery.