Aortorenal arterial autografts: long-term assessment.

Ninety-four iliac arterial autografts were placed in 86 hypertensive patients (age range, 7 to 57 years) during a 16-year period for renal artery reconstruction of nonatherosclerotic lesions. Ten patients were children, and nine patients had a solitary kidney. Ex vivo repair was used in 21 patients. There were no early postoperative deaths; one patient died three months postoperatively of unrelated disease. Two grafts occluded in the early postoperative period. Follow-up of one to 16 years (mean, 5.6 years) was available in 77 patients (93%). Forty-one patients underwent late arteriography at an average of 5.7 years postoperatively. Fifty-one patients (66%) were regarded as cured of their hypertension, the conditions of 25 patients (32%) improved, and the condition of one patient (1.2%) was unchanged. There were no late autograft occlusions. Atherosclerotic anastomotic stenosis developed in one autograft 13 years postoperatively and was relieved by reoperation. Dilation of one autograft was observed seven years postoperatively but did not increase on subsequent arteriograms. In five children, follow-up angiograms showed that the size of the autograft paralleled that of the contralateral renal artery. These results support the preferential use of an autograft during reconstruction of nonatherosclerotic lesions that cause renovascular hypertension.