Acute non-traumatic obstructions of the renal artery.

Twenty patients were operated upon for acute obstruction of their main renal arteries (25 kidneys at risk), 18 hours to 68 days after the onset of obstruction. Three nephrectomies were necessary because of total renal infarction but revascularization was possible in all the other cases. The postoperative mortality rate was 15%; definitive kidney salvage rate was 64%. The function of the preserved kidneys was usually satisfactory. This surgical experience has led us to the following conclusions: acute obstruction of a main renal artery does not necessarily cause renal infarction as viability of the kidney can be maintained over long periods of time by the collateral circulation; neither non-function of the kidney, nor the duration of renal artery obstruction must be regarded as signs of renal infarction; no investigation can provide information as to the exact condition of the kidney before surgery. Apart from critically ill patients or segmental renal obstructions, the treatment should be surgical, irrespective of the time that has elapsed from the onset of the obstruction.